Healthy Heart, Healthy Family: A Community Health Worker’s Manual for the Filipino Community

Full text

Originally published by the National Heart, Lung, and Blood Institute (NIH Publication No. 08-6339). U.S. government work, public domain. Reproduced as archived reference, not current guidance.

Healthy Heart, Healthy Family

A Community Health Worker’s Manual for the Filipino Community

Healthy Heart, Healthy Family

A Community Health Worker’s Manual for the Filipino Community

NIH Publication No. 08-6339 September 2008

Table o f Contents

Dear Community Health Worker Letter......................................................................... v

introduction

The Role of the Community Health Worker ............................................................... vii

Acknowledgments.......................................................................................................viii

About the “Healthy Heart, Healthy Family” Manual................................................. xiv

How To Use This Manual............................................................................................ xv

session 1

Knowledge Is Power: Know Your Risk for Heart Disease .......................................... 1

session 2

Act in Time to Heart Attack Signs ............................................................................. 29

session 3

Get Energized! Say YES to Physical Activity............................................................ 57

session 4

Help Your Heart: Control Your High Blood Pressure ............................................... 95

session 5

Be Heart Smart: Keep Your Cholesterol in Check .................................................. 143

session 6

Keep The Beat: Aim for a Healthy Weight .............................................................. 193

session 7

Protect Your Heart: Prevent and Control Diabetes................................................... 233

session 8

Welcome Heart Healthy Eating Into Your Home ..................................................... 283

Introduction iii

session 9

Eat in a Heart Healthy Way—Even When Time or Money Is Tight ....................... 325

session 10

Take Control of Your Health: Enjoy Living Smoke Free ........................................ 361

session 11

Review and Graduation ............................................................................................ 401

session 12

Use Evaluation To Track Your Progress (Especially for Community Health Workers) ............................................................ 435

appendix

Activities for Training Community Health Workers................................................. 495

for more information.......................................................................... 524

iv Healthy Heart, Healthy Family: A Community Health Worker’s Manual for the Filipino Community

Dear Community Health Worker:

Cardiovascular disease (CVD) is the #1 killer of all Americans and is one of the leading causes of death among Filipino Americans. High blood pressure, high blood cholesterol, overweight/obesity, smoking, not being physically active, and diabetes are all factors that increase a person’s risk of CVD. The good news is that people can lower their risk by making some lifestyle changes, and community health workers like you can help. The “Healthy Heart, Healthy Family” manual can guide you as you begin this journey.

“Healthy Heart, Healthy Family” is a heart health manual created especially for Filipino American communities by the National Heart, Lung, and Blood Institute (NHLBI) at the National Institutes of Health (NIH), U.S. Department of Health and Human Services (DHHS). The manual is taught by community health workers and focuses on helping people build skills to make practical, lasting changes to help fight heart disease and to improve their health. You will notice that cultural adaptations are used to make the manual more appealing and relevant to Filipino American communities.

The “Healthy Heart, Healthy Family” manual provides all the information you need to put this heart health project into action in your community. This manual can be used to train community health workers as well as to educate members of the Filipino American community, or it can serve as the basis for other community activities.

“Healthy Heart, Healthy Family” is dedicated to community health workers like you who devote time and energy to help others improve their health and live longer. Thank you for making a difference.

Much success,

Robinson Fulwood, Ph.D., M.S.P.H. Chief Enhanced Dissemination and Utilization Branch Division for the Application of Research Discoveries National Heart, Lung, and Blood Institute

Dear Community Health Worker v

The Role of the Community Health Worker

Community health workers play a key role in promoting better health in Filipino American communities. They help people learn about health issues and show them ways to live healthier lives. Without them, many Filipino Americans might not receive such vital information.

Successful community health workers have special qualities. They know their communities well. They are dedicated to improving the health of their communities. They enjoy teaching others, feel comfortable in front of a group, and know how to work with a group. Successful community health workers are also:

• Good listeners
• Caring
• Patient
• Fair
• Helpful
• Nonjudgmental
• Pleasant
• Approachable
• Openminded
• Confident

• Willing to try new ways to improve their own health

Let’s Hear From You!

We thank you for your interest and efforts to help Filipino Americans take steps to protect their hearts. We invite you to give us your feedback on how you are using the manual in your community.

Your feedback will help promote the expansion of the project in the United States and abroad and contribute to the growth of the Healthy Heart, Healthy Family network. Establishing a large network is important to keep the project going strong!

You may also send your feedback to:

Healthy Heart, Healthy Family Project NHLBI/Division for the Application of Research Discoveries 31 Center Drive, MSC 2480 Bethesda, Maryland 20892-2480 woov@mail.nih.gov.

Introduction vii

Acknowledgments

The “Healthy Heart, Healthy Family” manual was developed with the dedication of many people. NHLBI gratefully acknowledges the contributions of community health workers, families, individuals, groups, institutions, and organizations to the success of this manual. We appreciate the time they dedicated to reviewing the manual, sharing their knowledge, and providing continuous support:

Noilyn Abesamis-Mendoza, M.P.H.

Center for the Study of Asian

American Health

Marcia Aquino, R.N.

Association of Philippine Physicians

in Maryland (APPM) New York University School of Medicine Baltimore, MD New York, NY

Also representing:

Kalusugan Coalition, Inc.

Queens, NY, and Jersey City, NJ

Gloria Balaiz

Kokua Kalihi Valley Comprehensive

Family Services Honolulu, HI Nina Agbayani, R.N. Association of Asian Pacific Community Norma Benzon

Health Organizations (AAPCHO)

Oakland, CA

David Aguilar, M.A.

Project AsPIRE

Center for the Study of Asian

Volunteer

Sugar Land, TX

Michael Byun, M.P.A.

Asian Service in Action

Akron, OH American Health New York University School of Medicine Sefie Cabiao New York, NY International Community Health Services Also representing: Seattle, WA Kalusugan Coalition, Inc. Queens, NY, and Jersey City, NJ Yoyie Carlos-Castillo, R.N. Volunteer Sharonne Ancheta Hasbrouck Heights, NJ Kokua Kalihi Valley Comprehensive Family Services Norma Castillo, M.D. Honolulu, HI Association of Philippine Physicians in Maryland (APPM) Baltimore, MD

viii Healthy Heart, Healthy Family: A Community Health Worker’s Manual for the Filipino Community

Hong Chartrand, M.P.A., M.A. Asian Pacific Community in Action Phoenix, AZ

Merlita Compton Kokua Kalihi Valley Comprehensive Family Services Honolulu, HI

Ofelia Dirige, Dr.P.H., R.D. Kalusugan Community Services National City, CA

Chin Du, M.P.H., M.Ed. Health Promotion Council of Southeastern Pennsylvania, Inc. Philadelphia, PA

Lien Du Vietnamese Association of Illinois Chicago, IL

Diep N. Duong, R.N., Ph.D. Lt. Col., USAF, NC HQ PACAF/XPH Pacific International Health Affairs South East Asia Desk (Burma, Cambodia, Laos, Viet Nam) Hickam AFB, HI

Rico Foz Project AsPIRE Center for the Study of Asian American Health New York University School of Medicine New York, NY Also representing: Kalusugan Coalition, Inc. Queens, NY, and Jersey City, NJ

Purificacion Gac, M.D. Volunteer Honolulu, HI

Jesus Guarin Kokua Kalihi Valley Comprehensive Family Services Honolulu, HI

Beverly J. Quan Gor, Ed.D., R.D., L.D., C.D.E. Center for Research on Minority Health University of Texas M.D. Anderson Cancer Center Houston, TX

John Paul Jael Asian Human Services Chicago, IL

Edwin Jocson West Bay Filipino Multi-Service Center San Francisco, CA

Miyong T. Kim, R.N., Ph.D., FAAN School of Nursing Johns Hopkins University Baltimore, MD Tana M. Le West Seventh Community Center, Inc. St. Paul, MN

Marichu Lee Volunteer Honolulu, HI

Harvey Lee Institute for Family Enrichment Honolulu, HI

Introduction ix

Donna R. Lew American Heart Association San Francisco, CA

Maria Macatumbas Kokua Kalihi Valley Comprehensive Family Services Honolulu, HI

Potri R. Manis, R.N. Project AsPIRE Kalusugan Coalition, Inc. Queens, NY, and Jersey City, NJ

Carmen Lavilla-Cortez, Ph.D. Kalusugan Coalition, Inc. Queens, NY, and Jersey City, NJ

Estrella B. Manio, M.S., R.N., P.N.P. Chair, Filipino Community Health Council American Heart Association San Francisco, CA

Melen McBride, R.N., Ph.D. Stanford Geriatric Education Center Center for Education in Family and Community Medicine Stanford University School of Medicine Palo Alto, CA

Mary Cheryl B. Nacionales, M.P.H., CHES Women’s Health Partnership Director Community Health Partnership San Jose, CA

x

Vilma Nafarrete-Braga, L.M.S.W. Filipino American Human Services, Inc. Jamaica, NY

Phi-Loan Nguyen Boat People SOS Washington, DC

Phi-Nhung (Nina) Nguyen Boat People SOS Washington, DC

Thang D. Nguyen, Ph.D. Boat People SOS Falls Church, VA

Thoa Nguyen Vietnamese Community Health Promotion Project–UCSF Health is Gold! San Francisco, CA

Mario Oliveros Volunteer Santa Clara, CA

Leo Pandac, Ph.D. Pacific Asian Alcohol and Drug Program Los Angeles County Refugee Service Center Los Angeles, CA

Dung Pham Vietnamese Social Services of Minnesota (VSSMN) Vietnam Center St. Paul, MN

Healthy Heart, Healthy Family: A Community Health Worker’s Manual for the Filipino Community

Melga R. Rodriguez, M.A.Ed. Department of Public Health City and County of San Francisco Bicol University Legazpi City, Philippines

Teodulfo V. Rodriguez Volunteer Baypoint, CA

La Sarmiento, L.M.T. Volunteer Washington, DC

Fe Seligman Operation Samahan Health Clinic National City, CA

Henry Soliveres Project AsPIRE Center for the Study of Asian American Health New York University School of Medicine New York, NY Also representing: Kalusugan Coalition, Inc. Queens, NY, and Jersey City, NJ

Ho L. Tran, M.D., M.P.H. Asian & Pacific Islander American Health Forum (APIAHF) San Francisco, CA

Rhodora Ursua, M.P.H. Project AsPIRE Center for the Study of Asian American Health New York University School of Medicine New York, NY Also representing: Kalusugan Coalition, Inc. Queens, NY, and Jersey City, NJ

Mila Velasquez, M.N., R.N., C.S., APRN, BC Philippine Nurses Association of America Cerritos, CA

Dia Kim Vu Vietnamese Social Services of Minnesota (VSSMN) St. Paul, MN

Candice Wong, M.D., Ph.D. University of California, San Francisco Department of Physiological Nursing San Francisco, CA

Jing Zhang, Ph.D. Asian Human Services, Inc. Chicago, IL

Introduction xi

Special Recognition

NHLBI extends special recognition to the following individuals and organizations for assisting NHLBI in helping make the material culturally appropriate and for sampling selected sessions and/or activities of the manual with the community:

• Theresa P. Castillo, M.A., C.H.E.S.

Public Health Fellow U.S. Department of Health and Human Services Emerging Leaders Program Bethesda, MD

• Center for the Study of Asian American Health

New York University School of Medicine New York, NY

• American Heart Association

Asian Cultural Health Initiatives San Francisco, CA

• Kalusugan Coalition, Inc.

Queens, NY, and Jersey City, NJ

May the “Healthy Heart, Healthy Family” manual lead to a new cycle of action to strengthen and sustain heart health in the Filipino American communities.

xii Healthy Heart, Healthy Family: A Community Health Worker’s Manual for the Filipino Community

NHLBI Staff

Matilde Alvarado, R.N., M.S.N. Coordinator Minority Health Education and Outreach Activities Division for the Application of Research Discoveries Bethesda, MD

Janet de Jesus, M.S., R.D. Nutrition Education Specialist Division for the Application of Research Discoveries Bethesda, MD

Robinson Fulwood, Ph.D., M.S.P.H. Chief Enhanced Dissemination and Utilization Branch Division for the Application of Research Discoveries Bethesda, MD

Madeleine Wallace, Ph.D. Public Health Analyst Division for the Application of Research Discoveries Bethesda, MD

Terri Williams, M.S.A. Production Manager Division for the Application of Research Discoveries Bethesda, MD

Violet Ryo-Hwa Woo, M.S., M.P.H. Public Health Advisor Division for the Application of Research Discoveries Bethesda, MD

Contract Support

IQ Solutions, Inc. Rockville, MD

Introduction xiii

About the “Healthy Heart, Healthy Family” Manual

To teach the “Healthy Heart, Healthy Family” manual, the following materials are needed:

• “Healthy Heart, Healthy Family” manual and picture cards
• “Filipinos Take It to Heart: A ‘How-To’ Guide for Bringing Heart Health to

Your Community” highlights steps that can be taken to implement successful awareness-raising and health-promoting activities in the community to prevent and control cardiovascular risk factors.

• Six easy-to-read bilingual booklets on heart healthy living:

• Are You at Risk for Heart Disease?

• Help Your Heart: Control Your High Blood Pressure

• Keep the Beat: Aim for a Healthy Weight

• Be Heart Smart: Keep Your Cholesterol in Check

• Protect Your Heart: Prevent and Control Diabetes

• Be Heart Healthy: Enjoy Living Smoke Free

Ordering information for these materials appears in the Appendix.

xiv Healthy Heart, Healthy Family: A Community Health Worker’s Manual for the Filipino Community

How To Use This Manual

Community health workers, this manual is for you! The “Healthy Heart, Healthy Family” manual can be used to train community health workers. After you have been trained, you can conduct your own trainings and teach others how to be community health workers.

The “Healthy Heart, Healthy Family” manual consists of 12 sessions that include step-by-step instructions on how to teach 11 fun and educational sessions to community residents or patients. Each session is taught in motivational and interactive ways to keep the attention of the group members. Each session helps people learn what they can do to prevent heart disease. The manual includes worksheets and handouts for project participants (group members) to take home to read and share with family and friends.

It also includes a special session for community health workers on how to evaluate completed projects. This session helps community health workers determine how successful they have been in implementing their training and educational activities and helping community residents to adopt heart healthy habits. The Appendix features special training activities and teaching tips and explains how to start a project in their own communities. (See pages 495–525.)

“Healthy Heart, Healthy Family” Sessions

1. Knowledge Is Power: Know Your Risk for Heart Disease
2. Act in Time to Heart Attack Signs
3. Get Energized! Say YES to Physical Activity
4. Help Your Heart: Control Your High Blood Pressure
5. Be Heart Smart: Keep Your Cholesterol in Check
6. Keep The Beat: Aim for a Healthy Weight
7. Protect Your Heart: Prevent and Control Diabetes
8. Welcome Heart Healthy Eating Into Your Home
9. Eat in a Heart Healthy Way—Even When Time or Money Is Tight
10. Take Control of Your Health: Enjoy Living Smoke Free
11. Review and Graduation
12. Use Evaluation To Track Your Progress (Especially for Community Health Workers)

Introduction xv

Session Outline

Each session begins with a summary page that explains:

• What you want group members to do or learn
• Materials and supplies that you will need
• Worksheets and materials that you will hand out
• The session outline

Each session also includes five major parts:

• Part 1—Introducing the Session

• Welcome the group members.

• Review the information from the last session.

• Ask the group members to talk about their pledges. (See Part 5, Pledge

for Life!)

• Explain what you will talk about in today’s session.

• Part 2—Conducting the Session

• Present new information.

• Lead the group in fun and educational activities.

• Ask the group members questions.

• Let the group members ask questions about what they have heard.

• Part 3—Review of Today’s Key Points

• Ask questions to help the group members review what they have just learned.

• Emphasize the important points.

xvi Healthy Heart, Healthy Family: A Community Health Worker’s Manual for the Filipino Community

• Part 4—Lola’s Life Lessons: A Time To Reflect

• Lola shares her wisdom and the heart health changes she made to her lifestyle

behavior.

• She shares how she inspired heart health changes in her family and friends.

• Part 5—Pledge for Life!

• Help group members choose at lease one activity to make healthy lifestyle

changes that relate to the information they have learned during the session.

• Part 6—Closing

• Tell the group members that you enjoyed holding the session, and wish them

luck in meeting their pledges.

• Thank the group members for attending the session.

• Ask the group members what they thought of the session.

Symbols

The following symbols are used throughout the manual to let you know quickly what comes next:

Do an activity.

Use a picture card.

Give out a handout.

Help group members create a pledge for heart health.

Introduction xvii

Give out a recipe.

Do a training activity.

Picture Cards

You will use the “Healthy Heart, Healthy Family” picture cards with the manual to help present the information for each session. When you see the picture card symbol in the manual, you will know to show a picture that relates to the information you will be talking about. On the back of each picture card is a script in English and in Tagalog that you can read aloud while you show the picture card.

Breaks and Refreshments

You should take a short break about halfway through each session. You may want to use the time to do some easy stretches (see the “Stretching Activities” handout on pages 86-88). Another option is to serve a small healthy snack with water during the break. Snack ideas include light yogurt or fruit, or vegetables with low-fat dip, and water. Or you can make one of the recipes from this manual and have group members taste it.

Getting Started

At Least 6 Weeks in Advance

1. Find a location. Find a place to teach “Healthy Heart, Healthy Family” sessions in your area that people can get to easily. Call local clinics, schools, churches, and community centers. Reserve a room at a time when community members can attend.
2. Tell people about the project. Let community leaders and others know that you are offering the course. Ask clinic personnel, clergy, and caseworkers to recommend it.

xviii Healthy Heart, Healthy Family: A Community Health Worker’s Manual for the Filipino Community

These are some of the benefits of the course:

• The course can help participants and their families find out their own risk for

heart disease and learn how to lead healthier lives.

• Participants will learn low-cost cooking techniques, as well as how to eat

healthy foods, prevent heart disease, become more physically active, keep a healthy weight, prevent and control diabetes, and quit smoking.

• The course is also for participants who have risk factors for heart disease

or are under the care of a doctor because of heart disease. This course will guide participants to take steps to protect and improve their heart health.

• Participants will learn that, whatever your age or current health status, it is

never too late to take steps to protect your heart.

1. Advertise the sessions. Post flyers at health fairs and in community sites, such as clinics, grocery stores, churches, and other places in your community. (See the sample flyer on pages xxiii and 505.) Place course announcements in local media outlets.
2. Class size. A small group of about 10 to 12 people is best. Try to get about 20 people to sign up, because some may not show up for the class, and others may drop out.

At Least 1 Week Before Each Session

1. Read through the sessions, picture cards, and handouts. Read through these materials two or three times to be prepared.
2. Carefully read the information that you will present to the group members. Practice what you will say in front of a mirror or to a friend or family member. Be sure to use the picture cards. Also practice making a few healthy changes in your own life.
3. Review the instructions for each activity. Make a list of things you need to do before the session, such as making a food display or getting a videocassette recorder (VCR)/video home system (VHS), or DVD, and TV monitor. For some sessions, you will need to create lists of places where people can get their blood pressure, blood glucose (test for diabetes), or blood cholesterol checked.

Introduction xix

1. Pay attention to the “More Information” boxes. This extra information helps you answer questions from the group.
2. Ask a health educator, registered dietitian, nurse, or doctor to explain any information you do not understand. Contact these health professionals at your local hospital or neighborhood clinic.
3. Review the list of handouts, materials, and supplies you will need for each session.

• Make enough copies of the handouts for all group members.

• Gather all the materials and supplies needed to conduct the session.

The Day of the Session

1. Review the list of materials, supplies, and handouts. Make sure that you have everything.
2. Arrive 30 to 60 minutes ahead of time. This will allow you to set up the room, VCR/VHS, or DVD and TV monitor.
3. Tell group members when sessions will meet and how often.

Working With Your Group

Leading the Group

• Get to know the members of your group. They may have different

backgrounds, interests, and needs.

• Use words and terms that are familiar to the people in your group.
• Encourage group members to ask questions. Asking questions helps group

members apply the information to their own lives and remember what they have learned.

• Keep the sessions flowing smoothly so everyone is interested and involved.

• Be ready to deal with people who talk too much. Thank these people for

sharing their opinions. Then quickly ask if anyone else has something to share.

xx Healthy Heart, Healthy Family: A Community Health Worker’s Manual for the Filipino Community

• Help group members who do not read or write well in a way that will not

bring attention to them.

• Offer help, but do not force anyone to accept help.

• Change the activity to a group discussion.

• Be observant. Watch for clues from group members who do not understand or

do not want to share their thoughts, and try to give the information in a different way if you see these clues:

• Puzzled looks

• Wrinkled foreheads

• Looking away from you

• Being quiet

Motivating Group Members

• Praise or reward group members’ efforts in order to keep them motivated.

• Give praise when it is deserved. This gives more meaning to what you

are teaching.

• Praise people in front of others. This can help them stay committed.

• Encourage group members to share their opinions.

• Show interest in group members and what they have to say.

• Be patient. Some people may not speak because they have never been asked

to share their opinions in a group setting.

• Try to involve everyone in the discussion and activities, but do not force

anyone to speak. People will speak up when they become used to the group.

• Encourage participants to take small steps toward change.

• People are more likely to develop new habits if you promote small changes

slowly. This brings more success.

Introduction xxi

Getting People To Come

• Remind the group members that it is important to come to all the sessions.

Tell them that they will:

• Learn something new at each session.

• Help family members.

• Socialize and meet new people.

• Ask people to team up and call one another as a reminder to attend

the sessions. This encourages people to attend.

• Remind them of the meeting time and how long the sessions will last.

Answering Hard Questions

Remember that it’s okay not to know all the answers! Say that you will have the correct answer by the next session. Call a local health educator, registered dietitian, or nurse to find out the correct information.

Keeping People on Track

Give the correct information when a group member gives incorrect or incomplete information. Give the person credit for any part of his or her answer that is correct. Say that people often receive incorrect information and believe it to be true. Tell the group members that this is one important reason why they are taking the course—to get correct information.

And Finally . . .

Have a good time. You are doing an important service for yourself and your community. Thank you!

xxii Healthy Heart, Healthy Family: A Community Health Worker’s Manual for the Filipino Community

Did You Know…

Heart disease is one of the leading causes of death among Asians and Native Hawaiians and other Pacific Islanders.

In the Healthy Heart, Healthy Family project, you will:

Learn how to keep your heart and your family’s hearts healthy.

Find ways to increase your physical activity, eat in a heart healthy way, keep a healthy weight, and not smoke.

Learn how to talk to your family, neighbors, and friends about heart disease.

Enjoy videos, games, role playing, and other activities that make learning fun.

Get take-home materials that you can share with others.

.

Classes meet once a week for 11 weeks.

Sponsored by: ______________________________________________________________

Location: __________________________________________________________________

Day/Time: _________________________________________________________________

Classes begin on: ___________________________________________________________

For more information or to register, contact: ______________________________________

An Ounce of Prevention Is Worth a Pound of Cure!

The course is free.

Everyone who completes the classes will receive a certificate.

xxiii

Begin With a Heart

Use this shape to cut out the heart. You will use these heart shapes in Session 1. (See page 3.)

xxiv

s essi o n

Knowledge Is Power: Know Your Risk for Heart Disease

Objectives

By the end of this session, group members will:

• Know about the Healthy Heart, Healthy Family project.
• Know how the heart works and its importance.
• Know that heart disease is a serious health problem for Filipinos and is one of the leading causes of death.
• Know that heart disease can be prevented.
• Be able to name six risk factors for heart disease that can be prevented.
• Know other group members.

Materials and Supplies

To conduct this session, you will need:

• “Healthy Heart, Healthy Family” manual and picture cards
• Name tags
• Hearts cut from red felt (try to get the kind that has a sticky backing) or red construction paper. Use the shape on page xxiv to cut out the heart.
• Safety pins if not using felt with sticky backing

Session 1. Knowledge Is Power: Know Your Risk for Heart Disease 1

• Map of the Philippines
• Pushpins
• Blackboard and chalk or several large pieces of paper, a marker, and tape
• Clear container that is filled with 1 liter (about 4 cups) of water

Handouts

Give each group member these handouts during this session:

• “Map of the Philippines” (page 22)
• “Meet the de la Cruz Family” (page 23)
• “Are You at Risk for Heart Disease?” (page 24)
• A Day With the de la Cruz Family (pages 25–26)
• “Lola’s Life Lessons: Session 1” (page 27)

Session Outline

Introducing the Session

1. Welcome
2. Project Overview
3. Course Rules

Conducting the Session

1. Getting To Know Each Other
2. Getting To Know the Strength of the Heart

A. How the Heart Works

B. The Heart’s Structure

2 Healthy Heart, Healthy Family: A Community Health Worker’s Manual for the Filipino Community

1. Facts About Heart Disease
2. Risk Factor Activity
3. A Day With the de la Cruz Family (Optional)

Review of Today’s Key Points

Closing

Note: Read the “More Information” chart on pages 17–21 to be ready to answer questions from group members.

Introducing the Session

1. Welcome

• Introduce yourself as people walk in.
• Ask each person his or her name. Write it on a name tag. Give each person a name tag and a felt or paper heart.
• Ask group members to wear the name tags on their shirts. Ask them to place the felt or paper hearts where their own hearts are found.
• Welcome group members to the session. Tell them that you are very happy to see them.

2. Project Overview

Heart disease is the #1 reason why people die in this country. The National Heart, Lung, and Blood Institute, part of the National Institutes of Health, created the Healthy Heart, Healthy Family project to help Filipinos prevent heart disease.

Session 1. Knowledge Is Power: Know Your Risk for Heart Disease 3

Together, we will learn about the risk factors for heart disease. We will also learn things that you and your family can do to have healthy hearts.

• Show the names of the 11 sessions on the blackboard or on a large piece of paper taped to the wall.

1. “Knowledge Is Power: Know Your Risk for Heart Disease”
2. “Act in Time to Heart Attack Signs”
3. “Get Energized! Say YES to Physical Activity”
4. “Help Your Heart: Control Your High Blood Pressure”
5. “Be Heart Smart: Keep Your Cholesterol in Check”
6. “Keep The Beat: Aim for a Healthy Weight”
7. “Protect Your Heart: Prevent and Control Diabetes”
8. “Welcome Heart Healthy Eating Into Your Home”
9. “Eat in a Heart Healthy Way—Even When Time or Money Is Tight”
10. “Take Control of Your Health: Enjoy Living Smoke Free”
11. “Review and Graduation”

Please come to all of the sessions. I will lead the sessions, but I need each of you to participate. This will help you learn the information and enjoy the sessions more. Please feel free to ask questions. Your questions also help others to learn.

For some, the knowledge or information we cover may be as straightforward and simple as tying your shoe.

4 Healthy Heart, Healthy Family: A Community Health Worker’s Manual for the Filipino Community

To others, the sessions may introduce lots of new information. This may be as challenging as taking care of a sampaguita plant in cold weather so it grows into a strong, beautiful flower.

If there is something you do not understand, please ask a question. Your questions also help others to learn.

Hearing information, especially new information, is not the same as carrying out what the information says. I hope what you learn will help you and your family take action to prevent heart disease.

3. Course Rules

Note: This section will help group members feel comfortable with each other at these sessions. It also will make it easier for you to lead the sessions.

Everyone will feel more at ease if they know what to expect from this project. Before we begin, let’s talk about the best way to run the sessions. Let’s agree as a group on a few basic rules.

This course takes effort and time from each group member. It is important for you to attend each session and to arrive on time. Each of the sessions is about 2 hours long.

• Optional (if you are able to make changes) Ask:

• How often do you want to meet (once a week, twice a week, etc.)?

• Is this a good time to meet?

Note: If not, set a meeting time and location that is best for most of the group.

• Ask:

Is this a good place to meet?

Note: If not, decide on a location that is best for most of the group.

Session 1. Knowledge Is Power: Know Your Risk for Heart Disease 5

Here are some things you can do to help you learn the most from the sessions.

1. Feel free to ask questions.
2. Share your personal experiences. This will make the project mean more to all of us.
3. Try to stay on the subject. We have a lot of information to talk about in a short time.
4. (Optional) Call me at [telephone number] if you have questions or concerns about this course. I am here to help you in any way that I can.

Because you will share your experiences and opinions, we need to agree on a few things.

• Ask:

• Do you agree to keep other group members’ comments to yourself?

• Do you agree not to judge others?

• Do you agree to try to come to all of the sessions?

• Ask:

Do you have other rules that you would like to talk about?

Note: Allow a few minutes for group members to respond.

• Ask:

How many of you have heard this Ilocano proverb? The proverb reads, “Ang karunungan ay kayamanan mo, na di maaring manakaw sa iyo,” which means, “Knowledge is wealth that cannot be stolen.”

• Ask:

Would someone like to share what this proverb means to you?

6 Healthy Heart, Healthy Family: A Community Health Worker’s Manual for the Filipino Community

Note: Allow 2 to 3 minutes for group members to respond.

With knowledge, you can make positive changes in your life to keep your heart healthy. Later in this session, you will meet the de la Cruz family, and they will share with us their journey to heart health.

Conducting the Session

1. Getting To Know Each Other

We will begin today’s session by introducing ourselves and getting to know each other a little better.

Note: Before the session, post the map in a central place in the room. Keep the pushpins nearby for this activity.

• Give group members the “My Family Is From…” handout (page 22), and show the map of the Philippines.
• Ask group members to:

• Give their names and tell one or two things about themselves (for example,

where in the Philippines their families are from, or how long they have been living in the United States).

• Tell why they came to this course and what they hope to learn.

Note: Start this activity by going first. Tell the group where your family is from in the Philippines and why you are interested in heart health. Be honest, and talk about your own personal experience. Give each group member a chance to answer. Use the pushpins to mark on the map where the group members’ families come from in the Philippines.

Session 1. Knowledge Is Power: Know Your Risk for Heart Disease 7

While our families may come from different parts of the Philippines, we all view the family as the backbone of support, knowledge, and love. You can help your family and friends by being a good example, sharing with them what you learn, and encouraging them to live healthier lives. Thank you for making this effort.

I would like to introduce you to another family that will help guide us through each of these sessions, the de la Cruz family.

• Give each group member the “Meet the de la Cruz Family” handout (page 23). Ask for a volunteer to read.

2. Getting To Know the Strength of the Heart

Now that we know a little bit about each other and the de la Cruz family, let’s get to know a few facts about the heart.

A. How the Heart Works

The heart is a gift that represents strength, life, and love. The heart is an amazing part of the body. It can pump approximately 5 liters of blood every minute. It beats about 100,000 times a day.

Note: Hold up a clear container that has 1 liter (about 4 cups) of water in it. Remind the group that the heart pumps five times this amount of blood each minute.

The heart sends blood to the lungs to pick up oxygen. Then it delivers oxygen to all the cells in the body.

8 Healthy Heart, Healthy Family: A Community Health Worker’s Manual for the Filipino Community

You can feel the beat of your heart by taking your pulse. To find your pulse, gently place the index and middle fingers of one hand on the inside wrist of your other hand. Slide your two fingers toward the thumb side of your wrist until you feel a slight beating.

• Show group members how to do this.

B. The Heart’s Structure

• Show picture card 1.1.

The heart is a hollow, muscular, cone-shaped organ, about the size of a fist.

• Hold up your fist for the group members to see.
• Point out each part of the heart on the picture card.

• The heart has two upper chambers and two lower chambers.

• The upper chambers (right atrium and left atrium) receive blood.

• The lower chambers (right ventricle and left ventricle) pump blood.

• Show picture card 1.2.

• The heart is located in the middle of the chest. Did you place your felt or

paper heart in the correct spot?

• The heart is one of three main components of the circulatory system. The

others are blood vessels and the blood.

• The circulatory system is very important for sustaining life and is made of all

the vessels that carry the blood throughout the body.

Session 1. Knowledge Is Power: Know Your Risk for Heart Disease 9

• Blood vessels are long, hollow tubes of tissue, much like drinking straws.

There are various kinds of blood vessels. The main ones are called arteries (shown in red), veins (shown in blue), and capillaries (not shown).

• The circulatory system delivers oxygen and nutrients to cells in your body

and removes carbon dioxide and other waste products.

• Show picture card 1.3.

Note: Point to each artery and vein. Describe the following two steps while pointing to pictures 1 and 2.

Let’s go over the major veins and arteries.

1. Blood (with little oxygen) enters the right top chamber of the heart through the largest veins in your body. These veins are called the superior and inferior vena cava.
2. Blood then flows down to the right lower chamber so it can be pumped out to the lungs through the pulmonary arteries. In the lungs, waste (carbon dioxide) is removed from the blood. The blood then gathers more oxygen.

• Show picture card 1.4.

Note: Describe the two steps while pointing to pictures 3 and 4.

1. The blood, rich with oxygen, returns to the heart and enters the upper left chamber through the pulmonary vein.
2. The blood then flows down to the lower left chamber and is pumped out of the aorta to the rest of your body. Your left and right coronary arteries carry oxygen-rich blood to all parts of your heart.

10 Healthy Heart, Healthy Family: A Community Health Worker’s Manual for the Filipino Community

Heart disease is a condition that affects the heart muscle, heart valves, or the vessels of the heart. The major form of heart disease is coronary heart disease. Because the heart is such an important organ, you want to keep it free from heart disease. When the heart stops, life stops. So when you take care of your heart, you take care of your life.

3. Facts About Heart Disease

Note: Before the session, read the “More Information” chart on pages 17–21. This chart lists the risk factors for heart disease that you can do something about. It gives you steps you can take to prevent or lower those risk factors.

Now that we know how important the heart is, let’s talk about heart disease and what we can do to protect our hearts.

• Ask:

Do you know someone who has heart disease?

Note: Allow about 2 minutes for group members to respond.

• Show picture card 1.5.

Heart disease is a serious health problem for Filipinos.

• It is one of the leading causes of death among Filipinos in the United States.

• Filipino women have higher rates of blood pressure compared to other Asian

American women.

• In the Philippines, approximately 23 percent of Filipino adults (or one in four

adults) have high blood pressure (140/90 millimeters of mercury [mmHg] or more).

Session 1. Knowledge Is Power: Know Your Risk for Heart Disease 11

• Many people believe that a heart attack or stroke happens suddenly, because

of a scary experience, getting bad news, stress caused by work, family problems, worries, or having strong feelings such as anger.

• A heart attack or stroke may seem sudden, but the truth is that heart disease

develops over many years. It often starts when you are very young.

• Taking steps to prevent heart disease is important at any age. It is like

performing regular service on a car (for instance, changing the oil and checking the fluids and the tires). Car maintenance helps keep the engine running smoothly so that the car won’t break down on the road. In the same way, you need to take steps to care for your body so you can lower your chances of getting heart disease.

• This course will show you the steps you and your family can take to have

healthier hearts.

• Show picture card 1.6.

In many sessions, you will hear about something called a “risk factor.” Risk factors are traits or habits that make a person more likely to get heart disease. Some risk factors—such as age, family history, and gender—are things you cannot change. But the good news is that you can do something about some risk factors:

• High blood pressure

• High blood cholesterol

• Cigarette smoking

• Diabetes

• Overweight

• Not being physically active

12 Healthy Heart, Healthy Family: A Community Health Worker’s Manual for the Filipino Community

4. Risk Factor Activity

• Give each group member the “Are You at Risk for Heart Disease?” handout (page 24). Read aloud each risk factor. As you read each one, ask group members to check off the risk factors they have.

The more risk factors you have checked, the greater your risk for heart disease and stroke. Talk to your doctor about your risk.

This session will explain how these risk factors affect the health of the heart. It will also teach you ways that you and your family can prevent or control those risk factors. You will learn how to:

• Lose weight if you are overweight.

• Be physically active.

• Cut down on salt and sodium.

• Eat foods that are lower in saturated fat and trans fat.

• Eat more fruits and vegetables and low-fat milk and milk products.

• Get your blood pressure, blood cholesterol, and blood glucose (blood sugar)

levels checked.

• Take prescribed medications as your doctor tells you.

• Quit smoking if you smoke.

(Optional) Note: You can share information on The Heart Truth campaign described in the Appendix on page 506.

Session 1. Knowledge Is Power: Know Your Risk for Heart Disease 13

5. A Day With the de la Cruz Family (Optional)

• Ask:

How did you feel when you learned that you or your loved one(s) have risk factors for heart disease?

Note: Allow 3 minutes for group members to answer.

• Give each group member the “A Day With the de la Cruz Family” handout (pages 25–26).

People act in different ways when they learn they must make changes in their habits to lower their risk for heart disease. Let’s read the examples from the “A Day With the de la Cruz Family” handout.

• Ask a volunteer to read the handout.

Note: You can make puppets to represent each member of the de la Cruz family from socks or paper bags. Use glue, markers, and other craft scraps to give your puppets features and costumes.

• Add these answers if they are not mentioned:

• Which family member do you identify with the most?

• What reasons do you have to improve your health?

• What barriers keep you from making daily changes?

• What can you do to reduce these barriers?

Review of Today’s Key Points

• Ask:

What are the risk factors for heart disease that we can prevent or control?

14 Healthy Heart, Healthy Family: A Community Health Worker’s Manual for the Filipino Community

• Add these answers if they are not mentioned:

• Overweight and obesity

• Not being physically active

• High blood pressure

• High blood cholesterol

• Diabetes

• Smoking

It may be hard to change old, unhealthy habits and learn new healthy ones. This course will teach you what you need to know and how to make these changes slowly. Seeing you make healthy changes may make others want to make these changes, too.

Lola’s Life Lessons: A Time To Reflect

• Ask:

How did you feel (or how would you feel) when you learned that you or your loved ones have risk factors for heart disease? Allow 3 minutes for group members to answer.

In the de la Cruz family, Lola Idad will show us how she made healthy lifestyle changes.

Note: Give each group member the “Lola’s Life Lessons: Session 1” handout (page 27). Ask a volunteer to read the handout.

Session 1. Knowledge Is Power: Know Your Risk for Heart Disease 15

Please take a few minutes to reflect on Lola’s advice and how this applies to your life. At the bottom of the handout, there is a space called “A Time To Reflect.” Use this section to record your thoughts and feelings about this week’s session. Remember, this is for you and no one else.

Note: Give each group member 2 to 3 minutes to write down their thoughts.

Closing

• Ask:

Do you have any questions about the project?

Note: Give group members a moment to respond.

Thank you for coming today. What did you think of today’s session?

Note: Allow a moment for group members to respond.

In the next session, we are going to discuss the warning signs of a heart attack.

Note for Educator: Think about today’s session. What worked and what didn’t? Did the session help group members learn about their risk for heart disease?

16 Healthy Heart, Healthy Family: A Community Health Worker’s Manual for the Filipino Community

More Information

Heart Disease Risk Factors You Can Do Something About

RISK FACTORS High blood pressure High blood pressure (or hypertension) is

FACTS YOU NEED TO KNOW When your blood pressure is high, your heart works harder than it should to move blood to all parts of the body. If not treated, high blood pressure can lead to stroke (brain attack), heart attack, eye and kidney problems, and death.

called the silent killer because Check your blood pressure numbers (mmHg*): it often has no Level Systolic Diastolic symptoms, yet it can cause very Normal Less than 120 Less than 80 serious illness. Prehypertension 120–139 80–89

High Blood 140 or higher 90 or higher Prehypertension Pressure You do not have high blood *Millimeters of mercury pressure yet, but are likely to develop it in the future unless you adopt healthy lifestyle changes. High blood Check your total blood cholesterol number cholesterol (mg/dL*): Cholesterol in your arteries is like rust Level in a pipe. Desirable Less than 200 Low-density Borderline High 200–239 lipoprotein (LDL) is known as the High 240 or higher “bad” cholesterol.

†

Too much LDL Check your LDL cholesterol number (mg/dL): cholesterol can Desirable Less than 100 clog your arteries, which increases Near Desirable/Above Desirable 100–129 the risk of heart Borderline High 130–159 disease and High 160 or higher stroke.

• Milligrams per deciliter High-density

†

lipoprotein (HDL) The goal for LDL cholesterol is different for everyone. is known as the Your doctor can help you set your LDL goal. “good” cholesterol. HDL carries cholesterol away Check your HDL cholesterol number (mg/dL): from your arteries. HDL levels of 60 mg/dL or higher help lower your risk of heart disease. HDL levels below 40 mg/dL are a major risk factor for heart disease.

Check your triglyceride level (mg/dL): A normal triglyceride level is below 150.

TAKE THESE STEPS TO PREVENT HEART DISEASE

• Check your blood pressure once a year. Check it more often if you have high blood pressure.
• Aim for a healthy weight.
• Be physically active on most days.
• Choose and prepare foods with less salt and sodium.
• Eat more fruits, vegetables, and low-fat dairy products.
• If you drink alcohol, do so in moderation.
• If your doctor gives you blood pressure medicine, take it the way the doctor tells you.
• Get a blood test called a lipid profile at your doctor’s office. This test measures all your cholesterol levels (total, LDL, and HDL) and triglycerides.
• Get your blood cholesterol levels checked every 5 years if you are age† 20 or older.
• Learn what your cholesterol numbers mean. If they are high, ask your doctor how you can lower them.
• Choose foods that are lower in saturated fat, trans fat, and cholesterol.
• Aim for a healthy weight.
• Be physically active.

Take these other steps to control triglycerides:

• Limit candy, sweets, regular soda, juice, and other beverages high in sugar.
• Avoid smoking and alcohol. Smoking raises triglycerides and lowers HDL cholesterol. Excess alcohol also raises triglycerides.

More Information

Heart Disease Risk Factors You Can Do Something About

RISK FACTORS

Overweight/Obesity

Overweight/obesity occurs when extra fat is stored in your body. It increases your risk of developing high blood pressure, high blood cholesterol, heart disease, stroke, and diabetes.

Diabetes When the sugar in the blood is high, your body cannot use the food you eat for energy.

Prediabetes Prediabetes is when blood glucose levels are higher than normal, but not yet high enough to be diagnosed as diabetes. People with prediabetes are at higher risk of cardiovascular disease.

Not being physically active Not being physically active can double your chances of heart disease and take years off your life.

Smoking You put your health and your family's health at risk when you smoke.

FACTS YOU NEED TO KNOW TAKE THESE STEPS TO PREVENT HEART DISEASE

Check your body mass index (BMI) and waist measure: • Get your BMI and waist measured every 2 years or

Category BMI more often if your doctor

recommends it.

Underweight <18.5 Normal 18.5–24.9 • Aim for a healthy weight. Try

not to gain extra weight.

Overweight 25–29.9 Obese 30 or greater • If you are overweight, try to

lose weight slowly. Lose 1 to

• A waist measurement greater than 35 inches (88 cm) 2 pounds (0.45 kg to 0.91 kg) for a woman and greater than 40 inches (102 cm) for a week. a man increases the risk of heart disease.
• Eat smaller portions and be
• Other reports indicate that the BMI cutoffs for physically active for at least overweight (>23.0 kg/m2) and obesity (>25.0 kg/ 60 minutes daily. m2) in the Asian-Pacific region are lower than these current standards (Clinical Guidelines on the Identification, Evaluation, and Treatment of Overweight and Obesity in Adults).
• Diabetes is serious. You may not know you have it. • Find out if you have diabetes. It can lead to heart attacks, blindness, amputations, and kidney disease. • Get your blood glucose (blood sugar) level checked at least
• Being overweight is a major risk factor for type 2 every 3 years, beginning at diabetes. the age of 45. You should be tested at a younger age and

• Filipino Americans are at higher risk for type 2 diabetes than the non-Hispanic Caucasian population. • Adults should do at least 30 minutes of moderate physical activity on most days, preferably every day of the week.

more often if you are at risk for diabetes. • Stay active. You can build up to 60 minutes of exercise each day by being active for 20 minutes three times a day.

• Many adults need 60 minutes of moderate (mediumlevel) to vigorous (high-level) activity on most • Try walking, dancing, or days, preferably every day of the week, to prevent playing basketball. unhealthy weight gain.
• Adults who used to be overweight need 60 to 90 minutes of moderate physical activity every day to avoid regaining weight.
• Children and adolescents need at least 60 minutes of moderate to vigorous physical activity on most days.
• Cigarette smoking is addictive. It harms your heart • Stop smoking now, or cut and lungs. It can raise your blood pressure and blood back gradually. cholesterol and those of others around you.
• If you cannot quit the first time, keep trying.
• If you do not smoke, do not start.

Healthy Heart, Healthy Family: A Community Health Worker’s Manual for the Filipino Community

Karagdagang Impormasyon

Mga Kadahilanan ng Peligro sa Sakit sa Puso na Maaari Mong Gawin

MGA KADAHILANAN MGA KATOTOHANANG DAPAT MONG MALAMAN NG PELIGRO

Alta presyon Kapag mataas ang presyon mo sa dugo, nagtatrabaho Ang mataas na presyon nang husto ang iyong puso kaysa sa dapat nitong gawin ng dugo (o alta presyon) upang mapaandar ang dugo sa lahat ng mga bahagi ng

ay tinatawag na tahimik na mamamatay tao sapagkat madalas na wala itong mga sintomas, ngunit maaari itong magsanhi

katawan. Kung hindi magagamot, maaaring humantong sa stroke ang mataas na presyon ng dugo (atake sa utak), atake sa puso, mga problema sa mata at bato, at pagkamatay. Suriin ang mga bilang ng iyong presyon sa dugo (mmHg*): ng napakaseryosong karamdaman.

Antas Systolic Diastolic

Pauna sa alta presyon

Mas mababa Mas mababa Normal

Hindi pa mataas ang sa 120 sa 80 presyon ng dugo mo,

Paunang alta

ngunit malamang na 120–139 80–89

Presyon

magkaroon nito sa hinaharap maliban kung 140 o mas 90 o mas

Mataas na Presyon

nagamit mo ang mga mataas mataas malulusog na pagbabago

• Millimetro ng mercury sa uri ng pamumuhay.

Kolesterol sa mataas na Suriin ang bilang ng iyong kabuuang kolesterol sa presyon dugo (mg/dL*): Ang kolesterol sa iyong

Kanais-nais Mas mababa sa 200

mga ugat ay tulad ng kalawang sa isang tubo. Mataas na hangganan 200–239

Mataas 240 o mas mataas

Low-density lipoprotein Ang (LDL) ay kilala rin bilang “masamang” Suriin ang bilang** ng iyong LDL kolesterol kolesterol. Ang labis (mg/dL): na LDL kolesterol ay maaaring makabara Kanais-nais Mas mababa sa 100 sa iyong mga ugat,

Malapit sa Kanais-nais/ 100–129

na nagpapataas ng peligro ng sakit sa Mataas sa Kanais-nais

130–159

puso at stroke.

Mataas na hangganan

High-density Mataas 160 o mas mataas lipoprotein Ang (HDL) ay kilala bilang “mabuting”

• Milligramo sa bawat deciliter kolesterol. Inilalayo ng † HDL ang kolesterol sa Ang layunin sa LDL kolesterol ay magkakaiba para sa iyong mga ugat. bawat isa. Maaaring makatulong ang iyoong duktor sa pagtatakda mo ng iyong layunin sa LDL.

GAWIN ANG MGA HAKBANG NA ITO UPANG MAIWASAN ANG SAKIT SA PUSO

• Suriin ang iyong presyon ng dugo minsan sa isang taon. Suriin ito nang mas madalas kung mayroon kang mataas na presyon ng dugo.
• Maglayon ng isang malusog na timbang.
• Maging aktibong pisikal sa mga nakararaming araw.
• Pumili at maghanda ng mga pagkaing kaunti ang asin at sodium.
• Kumain ng mas maraming mga prutas, gulay, at low-fat na mga produktong dairy.
• Kung umiinom ka ng alcohol, gawin ang gayon nang katamtaman.
• Kung binigyan ka ng iyong duktor ng gamot para sa presyon ng dugo, inumin ito sa paraang sinabi sa iyo ng duktor.
• Kumuha ng pagsusuri sa dugong tinawag na isang lipid profile sa opisina ng iyong duktor. Ang pagsusuring ito ay sumusukat ng lahat ng mga antas ng kolesterol (kabuuan, LDL, at HDL) at mga triglyceride.
• Ipasuri ang mga antas ng iyong kolesterol sa dugo tuwing 5 taon kung ikaw ay nasa gulang na 20 o mas matanda.
• Alamin kung ano ang kahulugan ng mga bilang ng iyong kolesterol. Kung mataas ang mga ito, tanungin ang iyong duktor kung paano pababain ang mga ito.
• Pumili ng mga pagkaing mas mababa sa saturated fat, trans fat, at kolesterol.
• Maglayon ng isang malusog na timbang.
• Maging aktibong pisikal.

Isagawa ang ibang mga hakbang na ito upang makontrol ang triglycerides:

• Limitahan ang kendi, matatamis, regular na soda, inuming pritas, at iba pang mga inuming mataas sa asukal.
• Iwasan ang paninigarilyo at alcohol. Nagpapataas ng triglycerides ang paninigarilyo at nagpapababa ng HDL kolesterol. Ang labis na alcohol ay nagpapataas din ng triglycerides.

Session 1. Knowledge Is Power: Know Your Risk for Heart Disease

Karagdagang Impormasyon

Mga Kadahilanan ng Peligro sa Sakit sa Puso na Maaari Mong Gawin

MGA KADAHILANAN NG MGA KATOTOHANANG DAPAT MONG MALAMAN PELIGRO

• ------------

Suriin ang bilang ng iyong HDL kolesterol (mg/dL): Mga antas ng HDL ng 60 mg/dL o mas mataas ay makakatulong na babaan ang iyong peligro sa sakit sa puso. Ang mga antas ng HDL na mas mababa sa 40 mg/dL ay isang pangunahing kadahilanan ng peligro para sa sakit sa puso.

• ------------

Suriin ang iyong antas ng triglyceride (mg/dL):

Ang isang normal na antas ng triglyceride ay mas mababa sa 150.

Labis sa timbang/Sobrang Suriin ang iyong index sa bigat ng katawan (body katabaan mass index [BMI]) at sukat ng baywang: Nangyayari ang paglabis sa

Kategorya BMI

timbang/sobrang katabaan kapag ang labis na taba ay Kulang sa timbang <18.5 naipon sa iyong katawan. Normal* 18.5–24.9 Dinadagdagan nito ang iyong

Labis sa timbang* 25–29.9

peligro sa pagkakaroon ng

Sobra sa katabaan* 30 o mas mataas

mataas na presyon ng dugo,

kolesterol sa mataas na presyon ng dugo, sakit sa puso, stroke, at diyabetis.

• Ang isang sukat ng baywang na higit sa 35 pulgada (88 cm) para sa isang babae at higit sa 40 pulgada (102 cm) para sa isang lalaki ay nagpapataas ng peligro sa sakit sa puso.

• Ipinapahiwatig ng iba pang mga ulat na ang hangganan ng BMI para sa labis sa timbang (>23.0 kg/m2) at sobra sa katabaan (>25.0 kg/ m2) sa rehiyong Asya-Pasipiko ay mas mababa kaysa sa mga kasalukuyang pamantayan (Mga Tagubilin Pangklinika sa Pagkakakilala, Pagsusuri, at Paggamot ng Labis sa Timbang at Sobra sa Katabaan sa Mga Nasa Hustong Gulang).

Diyabetis Kapag mataas ang asukal sa katawan, hindi magagamit ng iyong katawan ang pagkain

• Ang diyabetis ay seryoso. Maaaring hindi mo alam na mayroon ka nito. Maaari itong humantong sa mga atake sa puso, pagkabulag, pagkaputol ng paa, at sakit sa bato. sa lakas.

• Ang pagiging labis sa timbang ay isang Paunang diyabetis pangunahing kadahilanan sa peligro para sa 2 uri ng diyabetis. Ang paunang diyabetis ay

kapag ang mga antas ng asukal sa dugo ay mas mataas sa normal, ngunit hindi pa

• Ang mga Filipino American ay nasa mas mataas na peligro para sa 2 uri ng diyabetis kaysa sa populasyong hindi pang-Hispanikong Caucasian. rin sapat na mataas upang masuri bilang diyabetis. Ang mga taong may paunang diyabetis ay nasa mas mataas na peligro ng karamdaman sa cardiovascular.

GAWIN ANG MGA HAKBANG NA ITO UPANG MAIWASAN ANG SAKIT SA PUSO

• Sukatin ang iyong BMI at baywtuwing 2 taon, o mas madalas kung inirerekumanda ito ng duktor.
• Maglayon ng isang malusog na timbang. Subukang huwag magdagdag ng timbang.
• Kung labis ka sa timbang, subukang magbawas ng timbang nang dahandahan. Magbawas ng 1 hanggang sa 2 libra (0.45 kg hanggang sa 0.91 kg) sa isang linggo.
• Kumain ng mas maliit na mga takal at maging aktibong pisikal nang hindi bababa sa 60 minuto araw-araw.
• Alamin kung mayroon kang diyabetis.
• Ipasuri ang antas ng iyong asukal sa dugo (asukal sa dugo) nang hindi bababa sa minsan tuwing 3 taon, simula sa gulang na 45. Dapat kang masuri nang mas maaga at mas madalas kung nasa peligro ka ng diyabetis.

Healthy Heart, Healthy Family: A Community Health Worker’s Manual for the Filipino Community

Karagdagang Impormasyon

Mga Kadahilanan ng Peligro sa Sakit sa Puso na Maaari Mong Gawin

MGA KATOTOHANANG DAPAT MONG MALAMAN NG PELIGRO

Pagiging hindi aktibong • pisikal Ang pagiging hindi aktibong pisikal ay maaaring magdoble ng iyong tsansa ng pagkakaroon ng sakit sa puso at maaaring makabawas ng taon ng iyong buhay.

Paninigarilyo • Inilalagay mo sa peligro ang kalusugan mo at ng iyong pamilya kapag nagsigarilyo ka.

UPANG MAIWASAN ANG SAKIT SA PUSO

Ang mga nasa hustong gulang ay dapat na gumawa nang hindi bababa sa 30 minuto ng katamtamang aktibidad na pisikal sa nakararaming mga araw, nararapat araw-araw sa isang linggo.

• Manatiling aktibo. Maaari kang makabuo ng hanggang sa 60 minuto ng ehersisyo sa bawat araw sa pamamagitan ng pagiging aktibo nang 20 minuto

tatlong beses isang araw. Maraming mga nasa hustong gulang ang nangangailangan ng 60 minuto ng katamtamang • Subukang maglakad, magsayaw, o (katamtamang antas) sa matitinding (mataas na maglaro ng basketball. antas) aktibidad sa mga nakararaming araw—dapat araw-araw—ng linggo, upang maiwasan ang hindi malusog na pagdaragdag ng timbang.

Ang mga nasa hustong gulang na dating labis sa timbang ay nangangailangan ng 60 hanggang 90 minuto ng katamtamang pisikal na aktibidad arawaraw upang maiwasan ang muling pagdaragdag ng timbang.

Ang mga bata at tinedyer ay nangangailangan nang hindi bababa sa 60 minuto ng katamtaman hanggang sa matitinding pisikal na aktibidad sa nakararaming mga araw.

Ang paninigarilyo ay nakaka-addict. Nakakasama • Tumigil na ngayon sa paninigarilyo, o ito sa iyong puso at mga baga. Maaari nitong taasan dahan-dahang itigil ang paninigarilyo. ang iyong presyon ng dugo at cholesterol sa dugo at

• Kung hindi mo maitigil sa unang ang mga iba pa sa paligid mo. pagkakataon, laging subukin.
• Kung hindi ka naninigarilyo, huwag magsimula.

Session 1. Knowledge Is Power: Know Your Risk for Heart Disease 21

My Family Is From …

Source: Adapted from http://i.infoplease.com/images/mphilipp.gif.

22 HAnDOuT—SESSiOn 1

Meet the de la Cruz Family of Healthy Heart, Healthy Family

A Filipino American Family’s Journey

This manual tells the story of the de la Cruz family’s successful journey to heart health. This family has encountered a lot of challenges since moving to the United States, but the de la Cruzes have found the strength to make positive changes in their lives.

With the grandmother’s—Lola Caridad’s (Idad)*— wisdom and determination, her family has achieved a healthy, well-balanced lifestyle. Lola wishes for all of her children to lead heart healthy lives. Only two of her children, Mila and Jose, and their families live close to her in the United States. Her other children still live in the Philippines, but they all visit each other and communicate often. Lola has learned from her mistakes that heart health is a gift to pass on to future generations, and she would like to share her knowledge with us as well.

Lola Idad will tell you the story of her family and show you how you can make the same journey to heart health. Although she knows the burden of heart disease can be overwhelming for a family, Lola will share practical steps that you can take to help keep your heart healthy. The sessions will help us learn from her family’s example.

Respect the gift of heart health by choosing a healthy lifestyle for you and your family!

• “Lola” is Tagalog for grandmother. Not only the family, but also the close network of community members respectfully addresses her as Lola. “Idad” is the nickname for her last name, Caridad.

HAnDOuT—SESSiOn 1 23

Are You at Risk for Heart Disease?

Name: ________________________________________________________________

Risk factors are traits or habits that make a person more likely to develop heart disease. Read this list of risk factors for heart disease. Check the ones you have.

Heart disease risk factors you can do something about:

Check the ones you have:

r Being overweight r High blood pressure r High blood cholesterol r Diabetes

r Not sure r Not sure r Not sure r Not sure r Not being physically active r Cigarette smoking

Heart disease risk factors you cannot control:

Check the ones that you have:

r Age (45 years or older for men and 55 years or older for women)

r Family history

• Father or brother with heart disease before age 55

• Mother or sister with heart disease before age 65

The more risk factors you have checked, the greater your risk for heart disease. Talk to your doctor about your risk.

24 HAnDOuT—SESSiOn 1

A Day With the de la Cruz Family

People react in different ways when they learn that they must make lifestyle changes to lower their chances of getting heart disease. Let’s review how the de la Cruz family acts when they get the news about their risk.

• Ric: “I don’t really care.” Ric learns that he is at risk for heart disease but he is not concerned. He gets upset when reminded about changing his unhealthy habits. He has no intention of making changes for better health. “Whatever will be, will be,” claims Ric.
• Mila: “I am stuck.” Mila is worried because she knows that smoking is a risk factor for heart disease, and is aware of the effect that secondhand smoking has on asthma. She thinks about making changes but cannot get started. She feels trapped and is not motivated to take steps for better health. “You can bring a horse to water but you cannot make it drink,” ponders Mila.
• Rose: “I am making plans.” Rose learns that her husband is at risk for heart disease and thinks that she should make changes. Instead of putting off her efforts until tomorrow, she asks her friends and family for suggestions on how she can make heart healthy changes for her family. “Walking the walk is harder than talking the talk,” says Rose.
• Lola (Mrs. Caridad de la Cruz): “I am taking action.” Lola learns that she is at risk for heart disease and quickly starts doing something about it. She goes to classes to learn how to improve her health. She practices what she learns. Lola makes simple changes and helps others to do the same. “An ounce of prevention is better than a pound of cure,” says Lola.
• Jose: “I stay on the healthy path.” Jose is making changes and is motivated to stay on track to improve his health. He knows that it is easy to fall back into old habits. He makes plans to prevent setbacks and learns to start again if he needs to. He is positive toward life. He asks for help and does not give up. “Time is gold and health is priceless,” says Jose.

HAnDOuT—SESSiOn 1 25

A Day With the de la Cruz Family (continued)

Now, please answer these questions:

1. With which family member do you identify?
2. What reasons do you have to make changes for better health?
3. What are the barriers that keep you from making changes to improve your health?
4. What can you do to overcome these barriers?

26 HAnDOuT—SESSiOn 1

Lola’s Life Lessons: Session 1

One of my favorite proverbs is:

“Aanhin pa ang damo, kung patay na ang kabayo.”

Translation: “What good is the grass if the horse is already dead?”

When the doctor told me I had high blood pressure, your Lola was surprised. I do not know of anyone in my family who had high blood pressure, but the doctor said my parents’ generation might not have known about all of their health conditions.

When I first came to the United States, I thought I was lucky to be able to afford such good food here. I never thought about whether the foods had too much salt or too much fat. And since living in the United States, I do not walk everywhere like I did in the Philippines. But now, I realize that life is too valuable to overlook these things.

I decided that I have to change my eating and physical activity habits to keep the horse from dying. What good is it if I am here, but unhealthy or suffering? How will I play with my grandchildren and help them become healthy adults? I have learned that knowledge is wealth that cannot be stolen, and I now eat healthy and do physical activity regularly. If I can change my habits at this age, anyone can. It really brings a lifelong reward to yourself and your family.

A Time To Reflect…

What things keep you from making lifestyle changes? What can you do to overcome these things?

(Use this space to write down your thoughts for this week’s session.)

HAnDOuT—SESSiOn 1 27

s essi o n

Act in Time to Heart Attack Signs

Objectives

By the end of this session, group members will learn:

• What a heart attack is
• Why it is important to seek treatment quickly if a heart attack happens
• The warning signs of a heart attack
• Why people delay seeking help for a heart attack
• The benefits of calling emergency medical services
• How to plan ahead

Materials and Supplies

To conduct this session, you will need:

• “Healthy Heart, Healthy Family” manual and picture cards
• “Act in Time to Heart Attack Signs” video
• Blackboard and chalk or several large pieces of paper, markers, and tape
• Videocassette recorder (VCR)/video home system (VHS) and TV monitor

(Optional) Note: Arrange for a health professional to come to the session to discuss cardiopulmonary resuscitation (CPR).

Session 2. Act in Time to Heart Attack Signs 29

Handouts

Give group members these handouts during this session:

• “Learn What a Heart Attack Feels Like” (page 47)
• “Fast Action Saves Lives” (page 48)
• “Fast Action Saves Lives: Role Plays” (pages 49–51)
• “My Emergency Card” (pages 52–53)
• “Lola’s Life Lessons: Session 2” (page 54)
• “Pledge for Life! Session 2” (page 55)

Session Outline

Introducing the Session

1. Welcome
2. Review of Last Week’s Session
3. About This Session

Conducting the Session

1. The Facts Don’t Lie
2. What Is a Heart Attack?
3. Importance of Rapid Treatment for a Heart Attack
4. What Are the Warning Signs of a Heart Attack?
5. Delay Can Be Deadly
6. The Role of Emergency Medical Services
7. How To Plan Ahead

30 Healthy Heart, Healthy Family: A Community Health Worker’s Manual for the Filipino Community

Review of Today’s Key Points

Lola’s Life Lessons: A Time To Reflect

Pledge for Life!

Closing

Introducing the Session

1. Welcome

• Welcome group members to the session.

2. Review of Last Week’s Session

At the last session, we talked about the risk factors for heart disease.

• Ask:

Who remembers the risk factors that we can prevent or control?

Note: Allow about 3 minutes for group members to respond.

• Add the following risk factors if they are not mentioned:

• Overweight and obesity

• Not being physically active

• High blood pressure

• High blood cholesterol

• Diabetes

• Smoking cigarettes

Session 2. Act in Time to Heart Attack Signs 31

• Ask:

Would any of you like to share what you are doing to improve your heart health?

Note: Allow about 2 minutes for group members to respond.

3. About This Session

Heart disease develops over many years. Sometimes, despite our best efforts, heart disease can result in a heart attack. That is why it is important to know the warning signs of a heart attack and what to do if you experience them. In today’s session, we will discuss the warning signs and the importance of taking quick action if you experience any warning signs. By the end of this session, you will know:

• How the heart functions

• What a heart attack is

• The importance of fast treatment for a heart attack

• The warning signs of a heart attack

• Why people delay seeking help for a heart attack

• The benefits of calling 9–1–1

• Steps you can take now to help you survive a heart attack

• How to prepare your emergency card

Lola Idad often says, “Kung ano ang ginawa mo, ay siya ring babalik sa’yo,” which means, “The act of self goes back to self.”

This proverb reminds Lola that the decisions she makes now will affect her later in life.

32 Healthy Heart, Healthy Family: A Community Health Worker’s Manual for the Filipino Community

Conducting the Session

1. The Facts Don’t Lie

• Each year about 1.2 million people in the United States will have a heart

attack, and about half of these people will die.

• About half of the people who die of a heart attack will die before they reach

the hospital.

To begin our session today, I would like to show a video about the importance of paying attention to heart attack warning signs.

• Show “Act in Time to Heart Attack Signs” video (14 minutes).

Now that we have seen the video, let’s talk about it.

• Ask:

• What did you see in the video?

• What did you hear in the video?

• How did the video make you feel?

Note: Allow about 5 minutes for group members to respond.

2. What Is a Heart Attack?

In the video, you heard facts about heart attacks. Now let’s talk about what a heart attack is and how one happens.

Session 2. Act in Time to Heart Attack Signs 33

• Show picture card 2.1.

A normal artery allows blood to flow freely.

A heart attack occurs when the blood supply going to a portion of the heart through one of the coronary arteries is blocked. Here is how this happens:

• Heart disease, which can lead to a heart attack, develops over time. Fatty

deposits build up on the inside of the coronary arteries. When this happens, the arteries become narrow and not enough blood, oxygen, and nutrients get through to meet the needs of the heart.

• The coronary arteries can become blocked, usually by a clot. When this

happens, the blood flow is closed off and a heart attack happens.

• If the blockage continues, part of the heart muscle will start to die.

• When a heart attack occurs, medical treatment can restore the blood flow to

the heart. This keeps the heart muscle from dying.

• Treatments work best if given as soon as possible, within 1 hour after

warning signs of a heart attack begin.

• When a part of the heart muscle dies, nothing can be done to restore it.

• Ask:

Are there any questions about what happens during a heart attack?

Note: Allow about 5 minutes for group members to respond.

34 Healthy Heart, Healthy Family: A Community Health Worker’s Manual for the Filipino Community

3. Importance of Rapid Treatment for a Heart Attack

• Treatments for heart attacks have improved over the years. Twenty years

ago, not much could be done to stop a heart attack.

• Today, there are treatments that can open up the heart’s arteries and restore

blood flow.

• “Clot-busting” medicines and other artery-opening treatments can break up

the clots and quickly restore blood flow to the heart.

• Show picture card 2.2.

• There is also a treatment called angioplasty. A balloon is placed in the

coronary artery and inflated to open the artery. This restores the blood flow.

• Sometimes with angioplasty, doctors will insert a stent. A stent is a wire

mesh tube that is used to open the artery.

• The stent stays in the artery and keeps it open to improve blood flow to

the heart.

• These treatments should be given as soon as possible, within 1 hour after

warning signs of a heart attack start.

• The more heart muscle that is saved, the better chance a heart attack patient

has of surviving and returning to a normal life.

4. What Are the Warning Signs of a Heart Attack?

It is important to know how to recognize a heart attack. This activity should help you learn the warning signs of a heart attack.

Session 2. Act in Time to Heart Attack Signs 35

• Ask:

What warning signs would make you think someone was having a heart attack?

Note: Write group members’ responses on a blackboard or on a large piece of paper taped to the wall.

• Give each group member the “Learn What a Heart Attack Feels Like” handout (page 47).
• Show picture card 2.3, and review the handout.

These are the warning signs most commonly reported by heart attack patients, both women and men:

• Discomfort in the center of the chest that lasts more than a few minutes—it

can feel like uncomfortable pressure, squeezing, fullness, or pain.

• Discomfort in one or both arms or the back, neck, jaw, or stomach

• Shortness of breath, with or without chest discomfort

• Cold sweat

• Feeling light-headed

• Nausea or feeling sick to their stomach

One myth about heart attack is that it only happens to men and not women. This is not true—heart attacks occur in both men and women. The most common heart attack warning sign for men and women is chest pain or discomfort.

The warning signs mentioned are the most common ones, and most people experience more than one of them. Some signs occur together. For example, chest discomfort often occurs with shortness of breath. Also, arm pain, sweating, and nausea may occur together.

36 Healthy Heart, Healthy Family: A Community Health Worker’s Manual for the Filipino Community

Many people think that all heart attacks happen the way you see in soap operas or in the movies—a person has crushing chest pain and falls to the floor. This is also a myth. The reality is that not all heart attacks happen this way. Many heart attacks start slowly, with signs gradually getting stronger.

• A heart attack is not always a sudden, deadly event. A variety of warning

signs may signal that someone is in danger.

• Sometimes the pain or discomfort is mild, and the signs may come and go.

• Ask:

What do you think are other reasons people do not recognize that they are having a heart attack?

Note: Allow about 5 minutes for group members to call out answers.

• Add the following reasons if they are not mentioned:

• People may confuse the warning signs of a heart attack with the symptoms of

other diseases or illnesses, such as asthma or flu.

• People may confuse heart attack signs with symptoms of a pulled muscle

or indigestion.

• Some people do not believe they are at risk for having a heart attack. When

they have warning signs, they ignore them or wait to see if the signs get worse before they call for help.

5. Delay Can Be Deadly

People often wait too long before they seek medical care for the warning signs of a heart attack.

• Some people wait 2 to 4 hours, or even a day or more, before getting help.

• If you think a heart attack is happening, the most important thing to

remember is this: Call 9–1–1 in 5 minutes or less.

Session 2. Act in Time to Heart Attack Signs 37

When people having heart attacks decide to seek help, they often do not call 9–1–1. Only half of all heart attack patients arrive at the hospital by ambulance.

• Give each group member the “Fast Action Saves Lives” handout (page 48).

Let’s go over how to take fast action when you think a heart attack is happening.

• Ask a volunteer to read the handout aloud.
• Ask:

Think about yourself and your family—what might prevent you from calling 9–1–1 quickly if you think you are having a heart attack?

Note: Allow about 5 minutes for group members to respond. Write their answers on the blackboard or on a large piece of paper taped to the wall.

• Add these reasons if they are not mentioned:

• They did not think their symptoms were severe enough.

• They were unaware that calling 9–1–1 has many lifesaving advantages.

• They thought driving themselves to the hospital would be faster.

• They were concerned about being embarrassed when an emergency vehicle—

ambulance or fire engine—showed up at their door.

• They were concerned about the cost of the ambulance and medical care.

• They were afraid of being embarrassed if the symptoms were a false alarm.

If you are having a heart attack, and you or someone else cannot call 9–1–1, have someone drive you to the hospital at once. Never drive yourself. You may pass out along the way, putting yourself and others in danger.

38 Healthy Heart, Healthy Family: A Community Health Worker’s Manual for the Filipino Community

It is easy to talk about what to do when a heart attack happens, but it is not so easy to take the right action if you or someone you know is actually having symptoms.

Lola Idad has taken steps to educate her family and friends on the importance of calling 9–1–1. Let’s take a look at some of the situations that Lola and her family have encountered over the years. We will act out different scenarios to prepare you for a real situation.

Note: Ask for volunteers in the group to form three teams of two people each. Give each team one of the three different role plays in the “Fast Action Saves Lives: Role Plays” handout (pages 49–51).

Note: Ask the teams to take a few minutes to read the role play, decide who will play the characters, and think about what they will say. Then ask each team to present their “drama” to the group.

• Ask:

Now that you have seen the three scenarios, what do you think is the main action you must take when someone is having the warning signs of a heart attack?

Note: Allow a moment for group members to call out the answer. If no one gives the correct answer, say:

The answer is to call 9–1–1 in 5 minutes or less.

6. The Role of Emergency Medical Services

Our actors did a great job of showing us why it is important to call 9–1–1 right away. Calling 9–1–1 is like bringing the hospital emergency department to your door.

Session 2. Act in Time to Heart Attack Signs 39

• Ask:

What are the benefits of calling emergency medical services?

Note: Allow 3 minutes for group members to respond.

• Add these answers if they are not mentioned:

• Emergency personnel arrive fast and can start treatment right away. They

may carry oxygen, heart medicine, pain relief medicine, aspirin, or other medications that can help in case of a heart attack.

• In many locations, emergency personnel are linked to the hospital. They can

send information about a patient’s condition to the emergency department before the patient arrives at the hospital.

• Heart attack patients who are brought by ambulance receive faster treatment

than patients who have someone drive them to the hospital.

• Your heart may stop beating during a heart attack. Emergency personnel

carry equipment to restart the heart if that happens.

Note: Most communities have the 9–1–1 system. However, if your community does not, say:

The best way to get the care you need is to call the local emergency medical number. In our community, that number is _____________________.

It is a good idea to plan ahead for who will take care of your family in an emergency. Emergency personnel will usually contact a relative or friend to make arrangements, if necessary.

• Ask:

What would you plan to do if you suddenly had to go to the hospital in an ambulance?

Note: Allow about 5 minutes for group members to discuss their answers.

40 Healthy Heart, Healthy Family: A Community Health Worker’s Manual for the Filipino Community

7. How To Plan Ahead

We have learned a lot today about heart attacks and what to do if one happens. Here’s the good news: Planning ahead with your family can help you survive a heart attack. Here are things you can do now to prepare for a possible heart attack.

• Show picture card 2.4.

You now know the warning signs of a heart attack. Talk to your family and friends about these signs and the importance of calling 9–1–1 right away.

• Show picture card 2.5.

You and other adults in your family should talk to your doctor about your risk of a heart attack and how to lower it.

• Show picture card 2.6, and give each group member the “My Emergency Card” handout (pages 52–53).

You and your family should have a plan of action in case of an emergency. This plan should include an emergency card. This card gives health care providers the information they need to know about you in case of an emergency.

Let’s look at the emergency card. The emergency card includes the following information:

• Name, relationship, and phone number of emergency contacts who should be

called if you have to go to the hospital

• Emergency numbers in your area

• Your health conditions

• Current medicines

Session 2. Act in Time to Heart Attack Signs 41

• Known allergies

• Name and phone number of your doctor or clinic

• Any other important information

Make copies for all adults in your family and encourage them to fill them out.

• Ask for volunteers to tell you how they would explain to their family members the importance of making a survival plan.
• Ask group members to tell you how they would make sure that all of their family members (such as a grandparent, spouse, or uncle) know what to do in case of a heart attack.

Note: Allow 2 or 3 minutes for group members to respond.

More Information

Aspirin: Take With Caution

A person who is thinking about using aspirin to treat or prevent heart problems should talk to a doctor first. If the doctor thinks that aspirin is a good choice, it is important to take the correct dose.

If a person has had a heart attack or stroke, aspirin can help lower the risk of a second one. It can also help keep arteries open in persons who have had heart surgery. It has also been shown that healthy women who take a low dose of aspirin every other day may prevent a first stroke. Aspirin may also prevent a first heart attack in women over the age of 65.

42 Healthy Heart, Healthy Family: A Community Health Worker’s Manual for the Filipino Community

Review of Today’s Key Points

Let’s review the main points that we learned today.

What is a heart attack?

• A heart attack occurs when a coronary artery becomes blocked and blood

flow is closed off.

• If the blood flow is stopped, parts of the heart muscle start to die.

What stops a heart attack?

• Quick action and medical treatment restore blood flow and save

heart muscle.

Why is it important to get treatment quickly?

• Quick treatment can prevent the heart muscle from dying.

• It is best to receive treatment within 1 hour after warning signs start. This

will improve chances of survival and will help save the heart muscle.

• “Clot-busting” and other medicines open up the artery and restore

blood flow.

• Angioplasty opens the artery and restores blood flow.

What are the warning signs of a heart attack?

• Your chest may hurt or feel squeezed.

• One or both of your arms, your back, or your stomach may hurt.

• You may feel pain in your neck or jaw.

• You may feel like you cannot breathe.

• You may feel light-headed or break out in a cold sweat.

• You may feel sick to your stomach.

Session 2. Act in Time to Heart Attack Signs 43

What should you do if you experience these warning signs?

• Call 9–1–1 in 5 minutes or less, even if you are not sure you are having a

heart attack. Calling 9–1–1 gets you treated more quickly.

• Do not drive yourself to the hospital.

Lola’s Life Lessons: A Time To Reflect

In the last session, Lola Idad reminded us that honesty and determination will help you make changes to prevent risk factors for heart disease.

Let’s see how Lola and the family have learned the signs of a heart attack and how important it is to call 9–1–1 immediately.

• Give each group member the “Lola’s Life Lessons: Session 2” handout (page 54). Ask a volunteer to read the handout.

Please take a few moments to reflect on Lola’s advice and how it applies to your life. At the bottom of the handout, there is a space called “A Time To Reflect.” Use this section to record your feelings about this week’s session. Please write down your thoughts. Remember, this is for you and no one else.

• Give group members 2 to 3 minutes to write down their thoughts.

44 Healthy Heart, Healthy Family: A Community Health Worker’s Manual for the Filipino Community

Pledge for Life!

You have learned a lot today about how to be prepared if a heart attack happens. Now let’s think about how you can practice what you have learned. Please think of one change you can make. This will be your pledge for the week.

• Give each group member the “Pledge for Life! Session 2” handout (page 55).

Take the pledge for life with Lola Idad and try to do one thing this week to be prepared if a heart attack happens. Be specific about what you plan to do, how you plan to do it, and when you will start. Here are some examples:

• Within the next week, I will think about what to do if a heart attack happens

at home, at work, in the middle of the night, or in other situations.

• I will talk with family and friends within the next week about the heart attack

warning signs and the need to call 9–1–1 right away.

• I will set up an appointment within the next month to talk to my doctor about

my heart attack risk.

Note: Allow 5 minutes for group members to think of a pledge.

Would anyone like to share his or her pledge with the group?

Note: Write down pledge ideas on the blackboard or on a large piece of paper taped to the wall.

Session 2. Act in Time to Heart Attack Signs 45

Closing

Thank you for coming today. What did you think of today’s session?

Note: Allow a moment for group members to respond.

The next session is about physical activity. Please wear comfortable clothing and walking shoes.

Note for Educator: Think about today’s class. What worked? What didn’t work? Do you think the session helped group members learn the warning signs for a heart attack and to call 9–1–1 immediately?

46 Healthy Heart, Healthy Family: A Community Health Worker’s Manual for the Filipino Community

Learn What a Heart Attack Feels Like

Act fast. Call 9–1–1. It could save your life.

Clot-busting medicines and other treatments can stop a heart attack as it is happening. These treatments work best if given within 1 hour of when heart attack signs begin. If you think you are having a heart attack, call 9–1–1 right away.

KnOW THE HEART ATTACK WARnInG SIGnS:

Your chest may feel You may feel discomfort You may feel pressure. in one or both arms, or the discomfort in your back or stomach. neck or jaw.

You may feel like You may feel light-headed You may feel sick you can’t breathe. or break out in a cold sweat. to your stomach.

HAnDOuT—SESSIOn 2 47

Fast Action Saves Lives

YOu MAY nOT BE SuRE IT IS A HEART ATTACK. A heart attack may not be sudden or very painful. You may not be sure what is wrong. But it is important to check it out right away.

ACT FAST. CALL 9–1–1.

Call 9–1–1 in 5 minutes or less. When you call 9–1–1, an emergency vehicle arrives Do not drive yourself to the hospital. right away. Medicines can be given at once.

TO HELP SuRvIvE A HEART ATTACK, TAKE THESE STEPS:

• Learn warning signs of a heart attack, and act fast if you feel them.
• Talk with family and friends about the warning signs and the need to call 9–1–1 right away.
• Ask your doctor about your heart attack risk and how to lower it.
• Complete the “My Emergency Card” handout.

48 HAnDOuT—SESSIOn 2

Fast Action Saves Lives: Role Plays

Role Play 1: At Home

Lola Idad is at home. Lola lives with her daughter, Mila. Lola and her longtime friend, Ligaya, are chatting over their midday snack (merienda) at the kitchen table.

Ligaya: Idad, I am not feeling my best today. My arm hurts a little and it feels uncomfortable here. I feel a little light-headed.

Lola: You do not look well. I went to that meeting at the community center. Dr. Cabaya talked about what to do if you or someone else has signs of a heart attack. He stressed that the first thing we should do is call 9–1–1.

Ligaya: Oh, I am sure it’s not anything serious. Maybe it’s my ulcer acting up again. I have been worried about my sister lately. Never mind, I’m sure I am fine. Are we going to play mahjong tonight?

Lola: No! You have some of the signs of a heart attack. Dr. Cabaya said that even if you are not sure it’s a heart attack, have it checked out immediately. Mila! Call 9–1–1 immediately while I stay with Ligaya. She needs an ambulance!

Mila, Lola’s daughter, enters the room panicked and calls 9–1–1.

Lola: Kumare (friend), if it is a heart attack, fast medical treatment can prevent damage to the heart. Getting to the hospital quickly means that you can be treated right away. Calling 9–1–1 may save your life!

HAnDOuT—SESSIOn 2 49

Fast Action Saves Lives: Role Plays (continued)

Role Play 2: At Work

Lola’s son-in-law, Cesar, is at work one afternoon and sees that his coworker Rolando does not look well.

Cesar: Rolando, are you okay?

Rolando: I haven’t been feeling well all morning. My stomach feels queasy and I feel light-headed. I don’t think it’s anything serious. Maybe it is just my morning breakfast—a little indigestion.

Cesar: Are you sure? You don’t look good.

Rolando: It’s okay. But my chest does feel heavy, and I have shortness of breath.

Cesar: You know, Rolando, those are signs of a heart attack. It is best to go to the hospital and get it checked out. I am going to call 9–1–1 right now!

Rolando: Cesar, how could I be having a heart attack? I am not even 50 yet! I’m still slim and I do physical activity regularly. I walk a lot. You are overreacting. If I still feel like this tomorrow, I will call my doctor for an appointment.

Cesar: Rolando, even if you are not 100 percent sure it’s a heart attack, you should check it out immediately. If it is a heart attack, fast medical treatment can prevent damage to your heart. Getting to the hospital quickly could save your life! I am calling 9–1–1 now.

50 HAnDOuT—SESSIOn 2

Fast Action Saves Lives: Role Plays (continued)

Role Play 3: At Night

Lola’s daughter, Mila, is home reading a magazine when she suddenly starts to feel very sick. No one else is home, so she telephones her brother, Jose, who is a nurse. He is not home.

Mila: Hi, Rose, is Jose there?

Rose: No, he is out bowling tonight. What’s wrong, Ate?* You sound upset.

Mila: Cesar took Mama (Lola) to the market, and I’m worried because I do not feel well. My neck hurts, and I have been in a cold sweat. And it is hard for me to breathe. I think I should drive myself to the hospital. Can you watch the kids while I go to the hospital?

Rose: Ate Mila, it sounds like you are having a heart attack. Do not drive yourself to the hospital. Call 9–1–1 right now! The medical team will treat you and get you to the hospital quickly.

Mila: No, I do not want to wake up the neighborhood and cause a big scene with the siren and lights. Also, I do not want to scare the kids. It is easier to drive myself to the hospital.

Rose: Ate, no! Call 9–1–1 right now! Once the ambulance comes, the medical team can start medical care immediately. And people who arrive by ambulance tend to get faster treatment when they get to the hospital.

You may not think you are having a heart attack because you’ve never had one before, but your symptoms sound like those of a heart attack. Call 9–1–1 right now. I am coming over.

Mila: Okay, Rose. I will call. Thank you.

• Ate refers to an elder sister.

HAnDOuT—SESSIOn 2 51

My Emergency Card

" "

OtherDiabetesHigh Blood PressurePrevious Heart AttackHeart DiseaseDo you have any of the following conditions?

______________

_______________________

___________________ Phone ________ _______ _____________

Home Phone:

Relationship q q q q YesYesYesYes

My Emergency Card

_____________ q q q q No No No No _______________________

Name Name:Date of Birth:Emergency Contacts:

________________________________________________________________________________________________________Other Information:Known Allergies:Current Medications: (Fold 2)

___________________ _____________________________________ ___________________________________

______________

________________

___________________________________ umbers n

___________________________________________

Family Doctor: _____________________________________Phone:Local Clinic/Hospital:Phone:EmergencyFire Department:Local Police Department:

Cut along dotted lines. Fold card in half and paste with a glue stick (Fold 1).Fold in half again to make your own personal wallet card (Fold 2).

" (Fold 1) "

52 HAnDOuT—SESSIOn 2

Aking Card na Pangkagipitan

"

___________

Telepono

Telepono sa Bahay:

Kaugnayan

___________

"

Iba paDiyabetisMataas na presyon ng dugoAtake sa Puso KamakailanSakit sa pusokundisyon?Nayroon ka ba ng anuman sa mga sumusunod na

___________________________ _______________________

__________

_________ ____

q q q q Oo Oo Oo Oo

q q q q ___________________________________________

Aking Card na Pangkagipitan

Pangalan Pangalan:Kapanganakan:Mga Contact na Pangkagipitan:

(2 tupi)

___________________________

HindiHindiHindiHindi

________________________________________________________________________________________________________Other Information:Mga Alam na Allergy:Mga kasalukuyang Paggagamot:

_____________________________________ ___________________________________

_________________________

___________________________________

_________________________________________ unerong Pangkagipitan n

Telepono:Panlokal na klinika/Ospital:Telepono:MgaFire Department: Duktor ng Pamilya: _________________________________

Gupitin sa tuldok-tuldok na mga linya. Itupi sa kalahati ang card at idikitgamit ang isang glue stick (1 Tupi). Muling tupiin sa kalahati upang magawaang iyong sariling pampersonal na card na pang-wallet (2 Tupi).

" (1 tupi)

HAnDOuT—SESSIOn 2

"

Lola’s Life Lessons: Session 2

One of my favorite proverbs is:

“Kung ano ang ginawa mo, ay siya ring babalik sa’yo.”

Translation: The act of self goes back to self.

My tatay (father) used to say this proverb all the time. He believed that the choices we made early on in life would affect our future. Making the best choices may not be the easiest path to take, but we have the power to move our lives in the right direction. Last year, my youngest son in Manila had a heart attack. The hospital said we were lucky that Santiago’s friends called the ambulance right away.

I was shocked when I heard the news. The only thing I ever wanted in life was for my family to be safe and healthy. I felt it was my fault, and maybe I should have taken better care of him when he was younger. But the doctor told us that there are some things we cannot control and others that we can control.

So, our family made changes to those things that we can control, like being prepared in case of an emergency. We learned the heart attack signs, and we keep all of our emergency cards by the phone. The entire de la Cruz family––even the children––knows that calling 9–1–1 immediately can save a life. Always remember, “the act of self goes back to self.”

A Time To Reflect…

Think about your daily routine. What choices have you made to lower your risk and your family’s risk of a heart attack? What are some new choices that can help you and your family act in time to heart attack signs?

(Use this space to write down your thoughts for this week’s session.)

54 HAnDOuT—SESSIOn 2

Pledge for Life! Session 2

Take the pledge for life with Lola Idad. Try to do at least one of these activities by yourself, with family, and/or share the activities with others.

Learn the heart attack warning signs.

Talk with family and friends about the warning signs and the need to call 9–1–1 in less than 5 minutes.

Remind your family and friends that it is better to be cautious and call 9–1–1 than be embarrassed about a false alarm.

Talk to your doctor about your heart attack risk.

Share your emergency card with other family members and/or friends.

Encourage family members and friends to have their own plans and emergency cards.

Remind your family and friends that both men and women are vulnerable to heart attack.

Check your blood pressure and cholesterol levels regularly.

Try to learn about your family’s history regarding risk factors associated with heart disease and cause of death.

Other

HAnDOuT—SESSIOn 2 55

s essi o n

Get Energized! Say YES to Physical Activity

Objectives

By the end of this session, group members will learn that:

• Physical activity is good for the heart and overall health.
• Adults should be physically active for 30 to 60 minutes on most days.
• Children and adolescents should be physically active for about 60 minutes on most days, preferably daily.
• Brisk walking is a simple activity that nearly everyone can do.
• There are ways to fit more activity into a busy schedule.

Materials and Supplies

To conduct this session, you will need:

• “Healthy Heart, Healthy Family” manual and picture cards
• Blackboard and chalk or several large pieces of paper, a marker, and tape
• (Optional) Index cards for physical activity guessing game*
• (Optional) Videocassette recorder (VCR)/video home system (VHS) or DVD and television

_______________

• Prepare before the session.

Session 3. Get Energized! Say YES to Physical Activity 57

• Cool drinking water and cups
• (Optional) Music for walking activity and tape or CD player

Handouts

Give group members these handouts during this session:

• “Role Play: Mila and Cesar Dance Their Way to Heart Health” (page 80)
• “Getting Started With Physical Activity” (page 81)
• “Getting Started With Physical Activity: Lola Idad’s Answers” (page 82)
• “Take Heart—Say Yes to Physical Activity” (pages 83–84)
• “Lola’s Tips for Staying Motivated” (page 85)
• “Stretching Activities” (pages 86–88)
• “Tips on Physical Activity” (page 89)
• “Make Physical Activity Part of Your Life—My Personal Record” (pages 90–91)
• “Sample Walking Program” (page 92)
• “Lola’s Life Lessons: Session 3” (page 93)
• “Pledge for Life! Session 3” (page 94)

Session Outline

Introducing the Session

1. Welcome
2. Review of Last Week’s Session
3. About This Session

58 Healthy Heart, Healthy Family: A Community Health Worker’s Manual for the Filipino Community

Conducting the Session

1. Facts About Physical Activity
2. Benefits of Physical Activity
3. Types of Physical Activity
4. (Optional) Physical Activity Guessing Game
5. Getting Started: Important Things To Know
6. Finding Time To Be Physically Active
7. Walking: An Activity for Almost Everyone*

A. Discussion and Stretching

B. Walking Activity

Review of Today’s Key Points

Lola’s Life Lessons: A Time To Reflect

Pledge for Life! Session 3

Closing

Note: If you have time, include a 30-minute activity, such as walking, at the beginning or end of each of the remaining sessions.

_______________

• Prepare for the walking activity by reading the “Tips for Preparing for the Walking Activity” box on page 73.

Session 3. Get Energized! Say YES to Physical Activity 59

Introducing the Session

1. Welcome

• Welcome group members to the session.

2. Review of Last Week’s Session

At the last session we talked about the heart attack warning signs. Who remembers the warning signs of a heart attack?

Note: Allow about 3 minutes for group members to respond. Write their answers on the blackboard or on a large piece of paper taped to the wall.

• Add these signs if they are not mentioned:

• Your chest may hurt or feel squeezed.

• You may feel pain in your neck or jaw.

• One or both of your arms, your back, or your stomach may hurt.

• You may feel like you can’t breathe.

• You may break out in a cold sweat.

• You may feel sick to your stomach.

• You may feel light-headed.

• Ask:

Who remembers what you should do if you feel these symptoms?

Note: Allow 3 minutes for group members to respond.

60 Healthy Heart, Healthy Family: A Community Health Worker’s Manual for the Filipino Community

The answers are:

• Call 9–1–1 in 5 minutes or less, even if you are not sure you are having a

heart attack. Calling 9–1–1 gets you treated more quickly.

• Do not drive yourself to the hospital.

At the end of the session, we pledged to do one thing to be prepared if a heart attack happens. Please share with the group what you did.

Note: Allow 2 to 3 minutes for group members to respond.

3. About This Session

During today’s session, we will discuss physical activity and how important it is to your heart health. When the session ends, you will know:

• How physical activity can help you and your family

• What kinds of activities are good for you and for your heart

• How much activity you should do

• How you can find time to be physically active

Note: “Physical activity” and “exercise” mean the same thing.

• Physical activity keeps you strong and healthy, both physically and mentally.

• Sometimes, it may seem hard to find the time for regular physical activity. In

the beginning, you may not look forward to it. Lola Idad has found a number of ways to build physical activity into her daily lifestyle and enjoy it.

Session 3. Get Energized! Say YES to Physical Activity 61

• Lola likes to say, “Walang mahirap na gawa pag dinaan sa tiyaga,” which

means, “No undertaking is difficult if pursued with perseverance.”

• Lola now knows the value of including physical activity in her and her

family’s daily routines.

Conducting the Session

1. Facts About Physical Activity

Not getting enough physical activity is a major health risk for people today.

• Not being physically active puts you at risk for heart disease. The good news

is that you can do something about this risk factor.

• Approximately one-third of Asians in the United States takes part in regular

physical activity.

• Filipino residents in the state of Hawaii do less physical activity compared to

the other Asian and Native Hawaiian residents.

• In the Philippines, approximately 15 percent of Filipinos participate regularly

in vigorous physical activity.

• In the Philippines, less than 8 percent of students aged 13 to 15 years old are

physically active for at least 60 minutes per day.

• As a person gets older, having little or no physical activity can lead to

health problems.

2. Benefits of Physical Activity

• Ask:

How do you think physical activity can help you?

62 Healthy Heart, Healthy Family: A Community Health Worker’s Manual for the Filipino Community

Note: Allow about 5 minutes for group members to respond. Write their answers on the blackboard or on a large piece of paper taped to the wall.

• Show picture card 3.1.

Physical activity can help you:

• Strengthen your heart • Feel better about yourself.

and lungs.

• Lower your stress. • Build and maintain healthy • Reduce feelings of

bones, muscles, and joints. depression and anxiety.

• Control your weight. • Sleep better. • Have more energy.

• Show picture card 3.2.

Physical activity can also help you:

• Lower your blood pressure.

• Control your blood cholesterol.

• Lower your risk of getting heart disease, diabetes, and some types of cancer.

• Show picture card 3.3.

People feel better when they are active. Physical activity may help you maintain a healthy weight or lose weight if you are overweight.

Let’s look at how Mila and Cesar found a physical activity group that fit their schedule and that they enjoy.

Note: Ask for three volunteers to act out the role play, “Mila and Cesar Dance Their Way to Heart Health” handout (page 80). Give the three volunteers a copy. As the trainer, you can read the introduction.

Session 3. Get Energized! Say YES to Physical Activity 63

3. Types of Physical Activity

• Ask:

What do you do to be physically active?

Note: Allow about 5 minutes for group members to respond. Write their answers on the blackboard or on a large piece of paper taped to the wall.

There are different types of physical activity. Physical activity includes some of the things that you probably do each day, like walking, climbing stairs, or doing household chores.

• Show picture card 3.4.

You may want to start with moderate (medium-level) activities. Moderate activities should require you to make some physical effort, but you should be able to have a conversation comfortably while doing them. Examples of moderate activities include:

• Walking at a brisk pace
• Gardening (mowing, raking)
• Dancing (ballroom, line, or
• Practicing tai chi or yoga
• Playing stickball or softball
• Bowling folk dancing)

• Doing floor exercises • Making home repairs (pushups, situps)

(painting)

• Playing with a hula hoop • Washing and waxing a car • Doing chair exercises • Scrubbing floors and (for seniors or persons

washing windows with disabilities)

• Weightlifting

• Show picture card 3.5.

64 Healthy Heart, Healthy Family: A Community Health Worker’s Manual for the Filipino Community

After a while, you will be able to do more vigorous (high-level) activities. Vigorous activities require hard physical effort and make your heart rate and breathing much faster. You usually cannot carry on a conversation comfortably while you are doing vigorous activities. Vigorous activities that you might enjoy include:

• Playing basketball, baseball, • Swimming laps

or kickball

• Practicing martial arts • Playing tennis (arnis, dumog/harimaw

buno, karate)

• Running or jogging • Jumping rope • Bicycling fast or uphill • Roller skating • Doing aerobics or floor exercises (calisthenics) • Performing heavy

construction work

4. (Optional) Physical Activity Guessing Game

Note: You can play a physical activity guessing game. Ahead of time, write the names of the 8 medium-level physical activities on index cards of one color and the 10 highlevel activities on index cards of a different color (listed on page 84).

• Divide participants into two groups, and give each person a card.
• Ask the medium-level activity group to go first. One by one, each person will act out the physical activity on his or her card. Ask the rest of the participants to guess the activity.

Follow the same process for the high-level activity group.

All types of physical activity are good for you. Aerobic activities, such as brisk walking that speeds your heart rate and breathing, help your heart. Other activities, such as weightlifting and stretching, can help improve strength and flexibility.

Session 3. Get Energized! Say YES to Physical Activity 65

Start slowly. Then move on to higher-level activities. For example, when you are comfortable walking, gradually begin to jog. You will feel great!

• Ask:

How much physical activity do you think you need to do each day to improve your health?

Note: Allow 1 to 3 minutes for group members to answer.

• Adults should have at least 30 minutes of moderate physical activity on most

days, preferably every day, to lower their chances of getting heart disease.

• Some adults need up to 60 minutes of moderate physical activity on most

days to prevent unhealthy weight gain.

• Adults who used to be overweight need 60 to 90 minutes of moderate

physical activity every day to avoid regaining weight.

• Children and adolescents need at least 60 minutes of moderate to vigorous

physical activity on most days, preferably daily.

• Show picture card 3.6.

If you cannot set aside 30 to 60 minutes at one time to be active, you can break your activity into shorter periods of 10 minutes or longer. It is the total time of physical activity that is important. Just make sure that the total time adds up to 30 to 60 minutes on most days.

66 Healthy Heart, Healthy Family: A Community Health Worker’s Manual for the Filipino Community

For example, if you can only do 30 minutes of physical activity a day:

• Practice tai chi or yoga for 10 minutes before you go to work ..................10

• Take a 10-minute walk with your kids after work..................................+10

• Practice dancing for 10 minutes later in the day.......................................+10

30 minutes

• Show picture card 3.7.

If you have more time, you can build up to 60 minutes a day with activities like these:

• Practice tai chi or yoga for 10 minutes before you go to work ................ 10

• Take a 15-minute walk with coworkers during your lunch break ..............15

• Walk the dog after dinner.......................................................................... 10

• Do housework for 15 minutes (carry out trash bags,

vacuum floors, put away groceries, scrub the bathtub) ............................. 15

• Practice dancing for 10 minutes later in the day......................................+10

60 minutes

• Ask:

Add it up: Do you get 30 to 60 minutes of physical activity during your workday?

• If so, that’s great!

• If not, start to do more physical activity to improve your heart health today!

Session 3. Get Energized! Say YES to Physical Activity 67

More Information

Just Move It

• Physical activity is important in weight control.
• Try to be physically active for 30 to 60 minutes on most days.

Here are some examples of how many calories you can burn from various activities for 30 minutes.

Activity Calories burned per 30 minutes*

• For a healthy 154-pound person. A lighter person burns fewer calories; a heavier person burns more.

Source: “The Compendium of Physical Activities Tracking Guide,” University of South Carolina, 2002.

68 Healthy Heart, Healthy Family: A Community Health Worker’s Manual for the Filipino Community

5. Getting Started: Important Things To Know

Note: This session provides information for people who are just starting to be active. It also helps people add more activity to what they already do.

There are a few things you should know before starting to be physically active.

• Give each group member the “Getting Started With Physical Activity” handout (page 81).

It’s very important to know when to talk with a doctor before starting a physical activity program. In the list on your handout, check which people should see a doctor before they begin physical activity.

Read the passages below while the group members check off the boxes.

Manuel is 65 years old and had a heart attack 10 years ago, but he is fully recovered.

Valentina is 32 years old and had a healthy baby 8 months ago.

Francisco is 38 years old and has diabetes, but he controls his condition very well with medication.

Roselle is 35 years old and wants to start being more physically active to lower her high blood pressure and help herself to quit smoking.

Bella is 27 years old and in good health, and she wants to start running.

Roberto is 57 years old and broke his leg 2 years ago, but it healed very well. He walks every day but wants to start jogging.

Note: Allow a few minutes for group members to discuss.

• Give each group member the “Getting Started With Physical Activity: Lola Idad’s Answers” handout (page 82).

Session 3. Get Energized! Say YES to Physical Activity 69

Let’s look at the handout to see what Lola Idad has to say about this.

Note: Go over the answers with the group.

These are Lola Idad’s answers:

Manuel should see a doctor before starting a physical activity program, because he has had a heart attack. Even though he is fully recovered, he should still check with his doctor.

Valentina does not need to see a doctor before starting a physical activity program. Having a baby is not a risk factor, and she is young.

Francisco should see a doctor before starting a physical activity program, because he has diabetes. Even though he is young and he controls his condition very well with medication, he should still check with his doctor.

Roselle should see a doctor before starting a physical activity program, because she has two risk factors: high blood pressure and smoking.

Bella does not need to see a doctor before starting a physical activity program. Even though she wants to start a harder activity, such as running, she is young (under 50 years old) and in good health.

Roberto should see a doctor before starting a physical activity program. His broken leg is not a factor, but he should check with the doctor first, because he wants to start a harder physical activity program, and he is more than 45 years old.

Here are some other things you should know before starting a physical activity program:

1. Start slowly. Build up the time and effort that you put into any activity. You should not be tired the next day.

70 Healthy Heart, Healthy Family: A Community Health Worker’s Manual for the Filipino Community

1. Drink plenty of fluids before, during, and after physical activity, even if you are not thirsty. Drink water. Water has no calories and will prevent you from becoming dehydrated. Special sports drinks are not needed.
2. Wear shoes and socks that give your feet support. Shoes with thick soles will cushion your feet and absorb shock.
3. Wear comfortable clothing. You do not need to buy fancy outfits.
4. Never wrap your body in plastic or wear clothing that is too heavy. This will not help you lose fat, but it can:

• Make you sweat too much.
• Make your body temperature rise.
• Make your heart beat too fast.
• Make you sick to your stomach.
• Cause you to pass out.
• Cause damage to your organs.
• Ask:

Does anyone have any questions?

Note: Give the group 2 to 3 minutes to ask questions.

You should also know that some people who are very overweight may face special challenges in trying to be physically active, but they, too, have good options.

Start with these activities:

• Weight-bearing activities, such as walking, involve lifting or pushing your own body weight.

Session 3. Get Energized! Say YES to Physical Activity 71

• Nonweight-bearing activities, such as swimming and water workouts, put less stress on your joints because you do not have to lift or push your own weight. If your feet or joints hurt when you stand, nonweight-bearing activities may be best for you.
• Lifestyle activities, such as gardening, do not have to be planned.

Note: For more information on being active at any size, visit the Weight-control Information Network at http://win.niddk.nih.gov/publications/active.htm, or call 1–800–946–4627 (toll free).

• Ask:

Does anyone have any questions?

Note: Give the group 2 to 3 minutes to ask questions.

6. Finding Time To Be Physically Active

I know that all of you have busy lives. You may be wondering how you will ever find time to be physically active. Let’s look at some ways.

• Give each group member the “Take Heart—Say Yes to Physical Activity” handout (pages 83–84). Read the handout aloud.
• Ask:

What are some other ways to become more active even when you don’t have much time?

Note: Allow about 5 minutes for group members to answer. Write their answers on the blackboard or on a large piece of paper taped to the wall.

• Add these ways if group members do not mention them.

• Take a 15- to 20-minute walk during your lunch break at work or after dinner

with your family.

• Jump rope a few minutes each day. Work up to jumping for 10 minutes.

• Dance with your children. You’ll burn calories and have fun together.

72 Healthy Heart, Healthy Family: A Community Health Worker’s Manual for the Filipino Community

Spend more time being active and cut down on watching TV and movies, using the computer, and playing video games.

• Give each group member the “Lola’s Tips for Staying Motivated” handout.

7. Walking: An Activity for Almost Everyone

Tips for Preparing for the Walking Activity

Before the start of this session:

• Review the “Stretching Activities” handout (pages 86–88).
• Practice until you know each part well enough to teach it to the group.
• Practice a brisk walk. Take long strides, swinging your arms.

When leading this activity, remember:

• Music can get people in the mood for being active. Use a lively song for the warmup exercises, a faster beat for the walking, and a relaxing song for the cooldown period. Make sure that no one objects to the music.
• Be enthusiastic. Group members will pick up on your enthusiasm and feel good about exercising.
• Lead the walk in a circle if you have to walk indoors or if space is limited.
• Have plenty of cool drinking water available before and after the activity.

Session 3. Get Energized! Say YES to Physical Activity 73

A. Discussion and Stretching

Brisk walking is an excellent form of physical activity. It’s easy to do and you do not need special equipment. All you need are shoes for support and socks for cushioning.

Walking can be done outdoors or indoors. If you do not feel safe walking in your neighborhood, a school or churchyard may be a safer place to walk. Walk in well-lit areas at night. Many shopping malls let people walk inside the mall before the stores open. Some malls even have walking clubs that meet every day.

It’s important to spend time warming up and cooling down each time you are physically active. Although the risk of injury from walking is low, the warmup gets your leg muscles ready for the activity. The cooldown lets your heart rate slowly return to normal. This keeps your leg muscles from getting stiff.

Note: Ask the group members to stand up and spread out, with at least 3 feet between them and other group members. Then, start the music.

It is important to warm up your muscles and stretch before you begin physical activity. First, we will warm up our muscles, and then we will stretch. Let’s walk in place slowly for 3 minutes.

Now, I am going to show you some stretching activities. Watch me, and then try doing them yourselves. Some are easier to do than others. With time and practice, you will be able to do them all. If you have a bit of trouble at first, just do your best. You will receive a handout that tells you how to do these stretching activities. Use the handout to help you do them at home.

74 Healthy Heart, Healthy Family: A Community Health Worker’s Manual for the Filipino Community

B. Walking Activity

Note: After the stretching activities, lead the group members on a 15- to 20-minute walk. Walk slowly for the first 5 minutes. Then show them how to do a brisk walk for 5 to 10 minutes. During the last 5 minutes, slow your pace.

We are slowing down now so that our bodies can gradually relax. This important part is called the cooldown period. It’s usually recommended that you gradually slow your pace during the last 5 minutes of an activity. Doing a few stretching exercises to loosen the muscles should also be part of your cooldown.

For example, runners or joggers may cool down by walking for a few minutes and then stretching their leg muscles before they stop entirely.

• Ask:

How do you feel? Do you think you could continue to walk like this? Why or why not?

Note: Allow 3 to 5 minutes for group members to respond.

If you already walk three or more times a week, add other activities to become more fit. Try jogging, jumping rope, or dancing.

One of the hardest parts of being more active is staying motivated. Many people find that having a partner helps them stay active. A partner can be a family member, neighbor, or friend. The benefits of having a partner are:

• You can motivate each other. You can set goals together and help each other

meet them.

• It makes the time go by faster. You focus on talking rather than on

the activity.

Session 3. Get Energized! Say YES to Physical Activity 75

Walking clubs are a great way to enjoy physical activity and make friends.

Note: See pages 507–509 in the Appendix for tips on how to organize a walking club, so you can share the tips with group members.

• Ask:

• What would help you stay motivated so that you continue being

physically active?

• Where are some safe places in your neighborhood to be active?

Note: Allow about 3 minutes for group members to answer. Write their answers on the blackboard or on a large piece of paper taped to the wall.

• Give each group member the following handouts: “Stretching Activities” (pages 86–88), “Tips on Physical Activity” (page 89), “Make Physical Activity Part of Your Life—My Personal Record” (pages 90–91), and “Sample Walking Program” (page 92).

Use the “Make Physical Activity Part of Your Life—My Personal Record” handout to track your daily progress.

Review of Today’s Key Points

Let’s review what we have learned today.

What are some of the benefits of regular physical activity?

Regular physical activity can help:

• Strengthen your heart and lungs.

• Build and maintain healthy bones, muscles, and joints.

• Help you lose excess weight and prevent weight gain.

76 Healthy Heart, Healthy Family: A Community Health Worker’s Manual for the Filipino Community

• Control blood cholesterol and lower blood pressure.

• Help you sleep better, reduce stress, increase energy, and reduce feelings

of depression.

• Lower your chances of heart disease, diabetes, and some types of cancer.

What is an activity that just about everyone can do?

• Brisk walking

What are simple ways to become more active throughout the day?

• Take a walk.

• Get off the bus early and walk.

• Dance to your favorite music.

What is the minimum amount of physical activity recommended for you to do every day?

• Adults need at least 30 minutes, and children and adolescents need at least

60 minutes daily.

Lola’s Life Lessons: A Time To Reflect

In the last session, Lola Idad reminded us that reflection can help us make heart healthy choices for the future. Although the choices may be hard, do not give up! If you stay with it, you can make lifestyle changes.

• Give each group member the “Lola’s Life Lessons: Session 3” handout (page 93). Ask a volunteer to read the handout.

Session 3. Get Energized! Say YES to Physical Activity 77

Please take a few moments to reflect on Lola’s advice and how it applies to your life. At the bottom of the handout, there is a space called “A Time To Reflect.” Use this section to record your thoughts and feelings about this week’s session. Remember, this is for you and no one else.

• Give each group member 2 to 3 minutes to write down some thoughts.

Changing from not being physically active to being physically active may take several attempts. It does not matter how many times you try, fail, and start again; the key is not to give up. Keeping a positive attitude will help you to continue taking steps toward a more physically active and healthy lifestyle.

Pledge for Life!

• Give each group member the “Pledge for Life! Session 3” handout (page 94).

You have learned a lot today about how you can become more physically active. Now, let’s think about how you can apply what you have learned. Please think of one change you can make in your everyday life to increase your level of physical activity. This will be your pledge for the week.

Be specific about what you plan to do, how you plan to do it, and when you will start. Examples include:

• I will talk to family members and friends this weekend about taking regular

walks together.

• I will start walking for at least 20 minutes during my lunch break at work,

starting tomorrow.

78 Healthy Heart, Healthy Family: A Community Health Worker’s Manual for the Filipino Community

Write your pledge on the “Pledge for Life! Session 3” handout. Keep this handout in a special place so you can review your pledges and keep your goal in mind.

Note: Allow 5 minutes for group members to think of a pledge and write it down.

Would anyone like to share his or her pledge with the group?

Note: Write down pledge ideas on the blackboard or on a large piece of paper taped to the wall.

We will talk about how you did with your pledges at the next session. Remember to keep working on your pledges to be prepared if a heart attack happens.

Closing

Thank you for coming today. What did you think of today’s session?

Note: Allow a moment for group members to respond.

I am looking forward to seeing you at the next session. The next session will be about how to cut back on salt and sodium to prevent and control high blood pressure.

Note for Educator: Think about today’s class. What worked? What didn’t work? Did the session motivate group members to include physical activity in their lifestyles?

Session 3. Get Energized! Say YES to Physical Activity 79

Role Play: Mila and Cesar Dance Their Way to Heart Health

Cesar and Mila’s two daughters take a folk dancing class. Their friend Helena’s son, Jun, also takes the class. Mila, Cesar, and Helena are talking while waiting for the children to finish folk dance practice.

Helena: This is Jun’s first time performing on stage. He is a little nervous about dancing at next month’s festival—and so am I!

Mila: Yes, but it is good for the kids. They love coming to practice, because they get to see their friends. And they learn about the Philippine culture. But I really like these classes, because once the kids have finished practicing, we adults get to dance!

Cesar: Yes! We usually do line or ballroom dancing. We have had so much fun that we asked the dance teacher to make it weekly.

Helena: Really? Aren’t we too old for that?

Mila: Oh, no! It gets us in shape for all the parties––the cotillions, weddings, and formal parties. Sometimes, the kids even join the line dancing.

Helena: That sounds like fun, but I do not have a lot of time.

Cesar: It is not really a lot of time. Since we are already here for the kids, it works out perfectly. We get to catch up with everybody and be a little physically active, too. The children love seeing us dance!

Mila: I was shy about getting started, but now I cannot wait for dance practice. This is a great physical activity that Cesar and I love doing! My doctor told me I need to stay physically active, and this is a great way to get your heart pumping and have fun, too.

Cesar: Please join us, Helena! Dancing will keep your heart and spirit young. The steps are simple. I will go slowly.

Helena: I do like this song—and I have always wanted to learn the steps. Okay—I will try it!

80 HAnDOuT—SESSIOn 3

Getting Started With Physical Activity

It’s very important to know whether to talk with a doctor before starting a physical activity program.

In the list below, check which people should see a doctor before they begin a physical activity program.

q Manuel is 65 years old and had a heart attack 10 years ago, but he is fully recovered.

q Valentina is 32 years old and had a healthy baby 8 months ago.

q Francisco is 38 years old and has diabetes, but he controls his condition very well with medication.

q Roselle is 35 years old and wants to start being more physically active to lower her high blood pressure and help herself to quit smoking.

q Bella is 27 years old and in good health, and she wants to start running.

q Roberto is 57 years old and broke his leg 2 years ago, but it healed very well. He walks every day but wants to start jogging.

HAnDOuT—SESSIOn 3 81

Getting Started With Physical Activity: Lola Idad’s Answers

q Manuel should see a doctor before starting a physical activity program, because he has had a heart attack. Even though he is fully recovered, he should still check with his doctor.

q Valentina does not need to see a doctor before starting a physical activity program. Having a baby is not a risk factor, and she is young.

q Francisco should see a doctor before starting a physical activity program, because he has diabetes. Even though he is young and he controls his condition very well with medication, he should still check with his doctor.

q Roselle should see a doctor before starting a physical activity program, because she has two risk factors: high blood pressure and smoking.

q Bella does not need to see a doctor before starting a physical activity program. Even though she wants to start a harder activity, such as running, she is young (less than 50 years old) and in good health.

q Roberto should see a doctor before starting a physical activity program. His broken leg is not a factor, but he should check with the doctor first because he wants to start a harder physical activity program, and he is more than 45 years old.

82 HAnDOuT—SESSIOn 3

Take Heart––Say Yes to Physical Activity

Regular physical activity can help your heart and lungs work better; lower your blood pressure, blood cholesterol, and blood glucose (blood sugar); and help you control your weight. It can also help you relax, feel less tense, sleep better, have more energy, and feel better about yourself. Physical activity can reduce your risk for diabetes and some types of cancer.

Make staying active part of your life.

Lola Idad has learned that the more physical activity you do, the easier it gets.

I do not wait until the end of the day when I am too tired to do any physical activity. I am active throughout the day. I take the stairs instead of the elevators and walk everywhere I can. Now I am up to walking 60 minutes a day with my friend Victoria. It helps to walk with someone. We are so busy talking, we walk even longer.

HAnDOuT—SESSIOn 3 83

Take Heart—Say Yes to Activity

Keep moving. Start slowly and work your way up!

Try to do at least 30 minutes of activity every day. If you’re short on time, try three or more 10-minute periods.

Start with light activities

• Slow walking
• Watering the lawn or garden
• Light house cleaning
• Fishing

Move to moderate activities

• Walking at a brisk pace
• Gardening (mowing, raking)
• Dancing
• Doing home repairs
• Practicing tai chi or yoga
• Washing windows and scrubbing floors
• Playing baseball
• Bowling

Increase to vigorous activities

• Playing tennis
• Playing basketball
• Practicing martial arts
• Running or jogging
• Bicycling fast or uphill
• Doing aerobics
• Swimming laps
• Jumping rope
• Roller skating
• Doing heavy construction work

Other things to do to help you and your family get started:

• Leave a pair of walking shoes in your

car.

to

Lola and her family have all increased their physical activity. They now dance and go for walks at the local park on weekends. Cesar, Ric, and Antonio have started a community basketball league at the local community center.

Your health and your family’s health are priceless. Value it!

DO

Lola’s Tips for Staying Motivated

Staying physically active is challenging, but do not give up! Use this sheet to help you plan your physical activity.

q Choose a physical activity that fits your lifestyle.

The physical activity I chose is q Set goals.

My short-term goal is to

My long-term goal is to q Start slowly.

My comfortable pace is q Get some support.

I will ask q Have fun!

q Add variety.

.

times a week.

times a week.

.

to join me in physical activity.

Different activities that I can do to stay physically active are

q Be flexible.

I will take time to rest when I feel q Track your success.

I will keep a record of my progress in a q Reward yourself.

My reward for doing physical activity regularly is

.

.

.

.

My reward for reaching my physical activity goal(s) is

Adapted from “Your Fitness Program: Tips for Staying Motivated,” Mayo Clinic.

HAnDOuT—SESSIOn 3

Stretching Activities

Do these stretches gently and slowly. Do not bounce.

1. Shoulder Stretches

Up and down five times on Arms down, breathe out. each side. Two times each.

1. Waist Stretches 6. Twists 7. Back and Leg Side to side three times Side to side three times Stretches

in each direction. in each direction. Down and up five times.

1. Leg Stretch 1 10. Leg Stretch 2

Hold onto ankle, four Down and up five times. times on each side.

86 HAnDOuT—SESSIOn 3

in each direction.

1. Back Stretch

Arms through legs six times.

1. Leg Stretch 3

Move heels up and down six times.

Magsimulang Kumilos Sa Mga Aktibidad sa Pag-uunat

Gawin ang mga pag-uunat na ito nang banayad at dahan-dahan. Huwag magpatalbug-talbog.

1. Malalim na

Paghinga

Itaas ang mga braso,

huminga paloob. Ibaba ang

2. Pag-unat ng

Leeg

Gilid sa gilid dalawang

beses.

mga braso, huminga palabas. Dalawang beses bawat isa.

4. Mga Pag-uunat ng Gilid Itaas at ibaba limang beses sa bawat bahagi.

5. Mga Pag-uunat ng Baywang Gilid sa gilid tatlong beses sa bawat direksyon.

HAnDOuT—SESSIOn 3

1. Pag-unat ng Balikat

Itaas at ibaba limang beses sa bawat bahagi.

1. Mga Pagpipilipit

Gilid sa gilid tatlong beses sa bawat direksyon.

Magsimulang Kumilos Sa Mga Aktibidad sa Pag-uunat (continued)

Gawin ang mga pag-uunat na ito nang banayad at dahan-dahan. Huwag magpatalbug-talbog.

7. Mga Pag-uunat ng Likod at Binti Pataas at pababa nang limang beses.

8. Pag-uunat ng Likod Abutin ng mga braso ang mga binti nang

9. Pag-unat ng Binti 1 Hawakan ang bukungbukong, apat na beses sa bawat bahagi.

anim na beses.

10. Pag-unat ng Binti 2 Pataas at pababa nang limang beses.

11. Pag-unat ng Binti 3 Igalaw ang mga sakong pataas at pababa nang anim na beses.

Binuo ng Programa ng Pagkontrol sa Diyabetis ng California, Kagawaran ng Mga Serbisyong Pangkalusugan, State of California.

88 HAnDOuT—SESSIOn 3

Tips on Physical Activity

Walk slowly for 5 minutes. Then do stretching exercises. (See handout on

1. stretching exercises.) 2. Walk briskly for 20 minutes.

3. Walk slowly for 5 minutes. 4. Relax!

Developed by the California Diabetes Control Program, Department of Health Services, State of California.

HAnDOuT—SESSIOn 3 89

Make Physical Activity Part of Your Life—My Personal Record

Name: _____________________________________________

Track your progress every day. Start out slowly.

Aim to reach 60 minutes or more each day!

Write down the number of minutes you are active each day.

Sunday Monday Tuesday Wednesday Thursday Friday Saturday

Example 5min. 5 10 10 15 15 15

Week 1

Week 2

Week 3

Week 4

Week 5

Week 6

Week 7

Week 8

90 HAnDOuT—SESSIOn 3

Gawing Bahagi ng Iyong Buhay ang Pisikal na Aktibidad—Aking Personal na Tala

Pangalan: _____________________________________________

Subaybayan ang iyong progreso araw-araw. Magsimula nang dahan-dahan.

Maglayong makaabot ng 60 o higit pa sa isang araw.

Isulat ang bilang ng minutong aktibo ka sa bawat araw.

Linggo Lunes Martes Miyerkoles Huwebes Biyernes Sabado

Halimbawang

5 min. 5 10 10 15 15 15

1 Linggo

Linggo 1

Linggo 2

Linggo 3

Linggo 4

Linggo 5

Linggo 6

Linggo 7

Linggo 8

HAnDOuT—SESSIOn 3 91

*

Sample Walking Program

Warm Up

Week 1 Walk slowly

5 minutes

Week 2 Walk slowly

5 minutes

Week 3 Walk slowly

5 minutes

Week 4 Walk slowly

5 minutes

Week 5 Walk slowly

5 minutes

Week 6 Walk slowly

5 minutes

Week 7 Walk slowly

5 minutes

Week 8 Walk slowly

5 minutes

• Do every day of the week.

Walk Cool Down Total Time

Walk briskly Walk slowly 15 minutes 5 minutes 5 minutes

Walk briskly Walk slowly 20 minutes 10 minutes 5 minutes

Walk briskly Walk slowly 25 minutes 15 minutes 5 minutes

Walk briskly Walk slowly 30 minutes 20 minutes 5 minutes

Walk briskly Walk slowly 35 minutes 25 minutes 5 minutes

Walk briskly Walk slowly 40 minutes 30 minutes 5 minutes

Walk briskly Walk slowly 45 minutes 35 minutes 5 minutes

Walk briskly Walk slowly 50 minutes 40 minutes 5 minutes

HAnDOuT—SESSIOn 3

Lola’s Life Lessons: Session 3

One of my favorite proverbs is:

“Walang mahirap na gawa pag dinaan sa tiyaga.”

Translation: “No undertaking is difficult if pursued with perseverance.”

Perseverance means to have courage and diligence. My doctor told me that physical activity is important to health. When he told me that physical activity can help control my high blood pressure, I knew I had to make some changes. I soon learned what the doctor meant. After I am physically active, my mind and body feel stronger. I feel balanced.

Your Lola has not always been this strong. Trying to become more physically active has been challenging! In the Philippines, I used to walk everywhere. I would even walk very far away to get to the market. But when I first came to the United States, I did not feel safe walking around. My friends are not nearby, and the U.S. does not have markets like the Philippines!

Now, I do my morning stretches and go for a walk every day. In the afternoons, I play with little Jo-Jo after he comes home from school. Sometimes we walk to the park, or we dance together while I sing karaoke. Every Thursday, I play mahjong at my friend’s house. Mila used to drive me, but now we walk together since it is only five blocks away and in a safe neighborhood.

It has not always been easy, but I do not give up! Nothing is impossible with perseverance.

A Time To Reflect…

What things keep you from being more physically active? What changes can you make in order to become more physically active?

(Use this space to write down your thoughts for this week’s session.)

HAnDOuT—SESSIOn 3 93

Pledge for Life! Session 3

Take the pledge for life with Lola Idad. Try to do at least one of these activities by yourself and/or share the activities with others.

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

Play with your children at the local park.

Start a weekly walking club or dance group.

Take an interest in a new hobby like ballroom dancing or tai chi.

Join a community garden project, or start your own garden.

Take the stairs instead of the elevator or escalator.

Take a 10-minute walk with a coworker during lunch.

Start a weekly bowling night with your friends.

Dance to some music!

Walk, do not drive, to your friend’s house.

Other

94 HAnDOuT—SESSIOn 3

s essi o n

Help Your Heart: Control Your High Blood Pressure

Objectives

By the end of this session, group members will learn:

• What blood pressure is
• That it is best to have a blood pressure below 120/80 mmHg (millimeters of mercury)
• That blood pressure between 120/80 and 139/89 mmHg is prehypertension
• That a blood pressure of 140/90 mmHg or greater is high
• What a stroke is and the warning signs of a stroke
• That eating less salt and sodium can lower the risk of developing high blood pressure
• That they can take steps to lower the amount of salt and sodium in their diets

Materials and Supplies

To conduct this session, you will need:

• “Healthy Heart, Healthy Family” manual and picture cards
• Blackboard and chalk or several large pieces of paper, a marker, and tape
• Measuring spoons (1 teaspoon)

Session 4. Help Your Heart: Control Your High Blood Pressure 95

• Small amount of salt
• Colored plate or plastic test tube

(Optional) Note: Arrange for a health professional to come to the session to take blood pressure readings.

Handouts

Give these handouts to each group member during this session:

• List of places where group members can get their blood pressure checked*
• “Know the Warning Signs of a Stroke. Act Quickly.” (pages 121–122)
• “Stroke Survival Tips” (page 123)
• “My Healthy Heart Wallet Card” (page 124)
• “Take Steps—Healthy Habits To Lower High Blood Pressure!” (page 125)
• (Optional) “Role Play: Lola’s Family Works Together To Control High Blood Pressure” (pages 126–127)
• “Read the Nutrition Facts Label for Sodium!” (page 128)
• “Ric’s Food Choices” (pages 129–131)
• “Sodium in Foods” (pages 132–133)
• “Keep Your Heart in Mind: Lola’s Tips To Eat Less Salt and Sodium” (pages 134–135)
• “Tips for Taking Medicine for High Blood Pressure” (pages 136–137)
• “Use Herbs and Spices Instead of Salt” (page 138)
• “Fish Cardillo Recipe” (page 139)

______

• Prepare this list before the session. You may find information at your local health department, hospital, or clinic.

96 Healthy Heart, Healthy Family: A Community Health Worker’s Manual for the Filipino Community

• “Lola’s Life Lessons: Session 4” (page 140)
• “Pledge for Life! Session 4” (page 141)

Session Outline

Introducing the Session

1. Welcome
2. Review of Last Week’s Session
3. About This Session

Conducting the Session

1. The Facts Don’t Lie
2. Facts About Blood Pressure and Stroke
3. Lowering High Blood Pressure
4. Salt and Sodium—How Much Do We Need?
5. (Optional) Lola’s Family Works Together To Control High Blood Pressure Role Play
6. Nutrition Facts Label Activity––Sodium
7. Shake the Salt and Sodium Habit
8. Easy on the Alcohol
9. Manage Your Blood Pressure With Medicine
10. Fish Cardillo Recipe

Review of Today’s Key Points

Lola’s Life Lessons: A Time To Reflect

Session 4. Help Your Heart: Control Your High Blood Pressure 97

Pledge for Life!

(Optional) Blood Pressure Check

Closing

Introducing the Session

1. Welcome

• Welcome group members to the session.

2. Review of Last Week’s Session

Last week, we talked about why you should be physically active. What do you remember about the benefits of being physically active?

Note: Allow about 3 minutes for group members to respond. Write responses on the blackboard or on a large piece of paper taped to the wall.

• Add the following benefits if they are not mentioned.

Physical activity:

• Strengthens your heart and lungs.

• Builds and maintains healthy bones, muscles, and joints.

• Helps you feel better about yourself.

• Helps you control your weight.

• Helps you lower your blood pressure.

• Helps you control your blood cholesterol.

98 Healthy Heart, Healthy Family: A Community Health Worker’s Manual for the Filipino Community

• Helps you sleep better.

• Helps you reduce stress and feelings of depression and anxiety.

• Helps you have more energy.

• Helps lower your chances of developing diabetes (high blood sugar), heart

disease, and cancer.

At the end of our last session, everyone made a pledge to be more active.

Note: Share with the group what you did and what barriers you faced.

• Ask:

Would any of you like to share with the group what you did? What problems did you face (such as not having time or not getting family support)? How did you solve them?

Note: Allow about 5 minutes for responses.

3. About This Session

Today’s session is about blood pressure and the steps you can take to lower your blood pressure or keep it from rising.

Last week, Lola Idad reminded us that staying strong and physically active comes from seeing the value of your goal and not giving up. She was able to get her family moving on the journey toward a healthier heart.

Lola strongly believes that “Kung may itinanim, may aanihin,” which means that if you plant, you will harvest. Lola has found that trying to reach a goal is like growing a plant. A plant needs care and nurturing beyond just potting it. In this session, Lola will share some useful tips based on her success in lowering her blood pressure.

Session 4. Help Your Heart: Control Your High Blood Pressure 99

Conducting the Session

1. The Facts Don’t Lie

• More than 65 million people (one in three) in the United States have high

blood pressure, which is also called hypertension. Nearly a third of these people don’t know they have high blood pressure.

• Another 59 million Americans have prehypertension, which means they are

at risk for developing high blood pressure.

• Studies in California find that more Filipino Americans have hypertension

than other Asians, Native Hawaiians and other Pacific Islanders, and Caucasians.

• Stroke is the third leading cause of death among Filipino Americans.

2. Facts About Blood Pressure and Stroke

• Show picture card 4.1.

Blood pressure is the force of blood against the walls of your arteries. Blood pressure is needed to move the blood through your body.

• Show picture card 4.2.

Blood pressure is recorded as two numbers––the systolic pressure (as the heart beats) over the diastolic pressure (as the heart relaxes between beats).

100 Healthy Heart, Healthy Family: A Community Health Worker’s Manual for the Filipino Community

The measurement is written one above the other, with the systolic number on top and the diastolic number on the bottom. For example, a blood pressure measurement of 120/80 mmHg (millimeters of mercury) is expressed verbally as “120 over 80.”

It is important to keep track of your blood pressure numbers. Write down your numbers every time you have your blood pressure checked.

• Ask:

Do you know your blood pressure numbers?

Note: Allow about 2 minutes for responses.

Note: Copy this chart on the blackboard or on a large piece of paper taped to the wall.

Your Blood Pressure Numbers

First Number Second Number

pressure.

It is time to make changes in your eating and physical activity habits. Visit the doctor if you have diabetes.

High blood 140 or greater 90 or greater Ask your doctor or nurse pressure how to control it.

Session 4. Help Your Heart: Control Your High Blood Pressure 101

A normal blood pressure is less than 120/80 mmHg. Blood pressure of 120/80 mmHg to 139/89 mmHg is prehypertension. This means that you do not have high blood pressure yet, but are likely to develop it in the future, unless you make changes in your health habits. Blood pressure is high when it is 140/90 mmHg or greater.

• Show picture card 4.3.

If you have high blood pressure or hypertension, it means your heart has to pump harder than it should to get blood to all parts of your body. High blood pressure raises your chances of having a stroke, heart attack, kidney problems, or becoming blind.

High blood pressure is known as the “silent killer” because it often has no symptoms. Most people who have it do not feel sick until they have a stroke, heart attack, or some other problem caused by high blood pressure.

High blood pressure is a major risk factor for stroke. Other risk factors that increase your chances of having a stroke include heart disease, smoking, diabetes, high blood cholesterol, and overweight/obesity.

• Ask:

Do you know anyone who has had a stroke?

Note: Allow a few minutes for group members to respond.

• Give group members the handout “Know the Warning Signs of a Stroke. Act Quickly.” (page 121).
• Show picture card 4.4.

102 Healthy Heart, Healthy Family: A Community Health Worker’s Manual for the Filipino Community

A stroke is also called a brain attack. A stroke happens when blood suddenly stops going to the brain and brain cells die. A stroke is very serious and can lead to disability and death.

The warning signs of a stroke happen suddenly. A person may have one or more warning signs. The warning signs of a stroke include:

• Numbness of the face, arm, or leg (especially on one side of the body)

• Confusion, trouble talking, and difficulty understanding others

• Trouble seeing with one or both eyes

• Trouble walking, dizziness, and loss of balance or coordination

• Severe headache

Ministrokes—or transient ischemic attacks (TIAs)—have the same symptoms as a stroke, but they do not last as long and usually do not cause brain damage. A ministroke is a warning that a stroke may happen in the future.

Ministrokes may last a few seconds or an entire day and then go away. These signs should not be ignored. As with a heart attack, act immediately if you or someone you know has stroke symptoms. Calling 9–1–1 right away will help prevent serious problems.

• Give group members the “Stroke Survival Tips” handout (page 123). Ask a group member to read aloud.
• Show picture card 4.5.

Session 4. Help Your Heart: Control Your High Blood Pressure 103

Measuring blood pressure is easy and does not hurt. The best way to find out if you have high blood pressure is to have it checked at least once a year. Check it more often if you already have high blood pressure or prehypertension.

• Give group members:

• A list of places (such as clinics and hospitals) to get blood pressure checked

• The “My Healthy Heart Wallet Card” handout (page 124)

Ask for your numbers each time you have your blood pressure checked. Keep a record of each reading on the wallet card.

3. Lowering High Blood Pressure

Ask group members to raise their hands if someone in their family has high blood pressure.

If a member of your family has high blood pressure, you are at greater risk of getting it, too. Even if you do not have high blood pressure now, you are still at greater risk if a family member has it.

The good news is that you can take steps now to lower your blood pressure or keep it from rising. Let’s find out how.

• Give each group member the “Take Steps—Healthy Habits To Lower High Blood Pressure!” handout (page 125).
• Read aloud the steps to lower high blood pressure or keep it from rising.
• Ask:

Which steps could you and your family take to prevent or lower high blood pressure?

104 Healthy Heart, Healthy Family: A Community Health Worker’s Manual for the Filipino Community

Note: Allow 3 minutes for group members to respond.

4. Salt and Sodium—How Much Do We Need?

Note: For this activity, you will need a ¼-teaspoon measuring spoon, a 1-teaspoon measuring spoon, and some salt. Use a colored plate or plastic test tube to show the sodium levels.

Even though salt is commonly seen as a symbol of good luck, eating less salt and sodium can help you prevent or lower high blood pressure. You know what salt is, but you may wonder what sodium is. Sodium is a part of salt. It is also part of mixtures used to flavor and preserve foods.

Most people are eating much more than 500 milligrams of sodium every day.

You should cut back the amount of sodium you get from all foods and beverages to less than 2,300 milligrams of sodium—or about 1 teaspoon of salt—per day.

Note: Now show 1 teaspoon of salt.

If you have high blood pressure, it would be helpful to decrease your sodium intake to 1,500 milligrams of sodium per day.

Note: Now show /3 teaspoons of salt.

Most people in the United States eat about 4,000 to 6,000 milligrams of sodium each day, or about 2½ teaspoons.

Note: Now show 2½ teaspoons of salt.

Session 4. Help Your Heart: Control Your High Blood Pressure 105

This is about 8 to 12 times more sodium than the body needs. Eating this much salt and sodium may lead to high blood pressure.

• Show picture card 4.6.

Let’s talk about what foods are high in sodium.

• Most of the sodium that we eat comes from packaged foods, restaurants, and

fast food. Examples of packaged foods are:

• Sauces and seasonings, such as soy sauce, patis (fish sauce), tuyo (salty dried fish), and bagoong alamang (salted shrimp paste)
• Regular canned soups and vegetables
• Frozen dinners
• Salty chips
• Canned meat, such as pork and sausages, and fish and seafood, such as salmon, squid, and sardines
• Meats high in sodium, such as hotdogs and bacon

• When you eat out, most of the food will be high in sodium. If you have high

blood pressure, you should eat out less often.

• Sodium also comes from salt added during cooking or at the table.

5. (Optional) Lola’s Family Works Together To Control High Blood Pressure Role Play

• Give group members the “Role Play: Lola’s Family Works Together To Control High Blood Pressure” (pages 126–127) handout.

Note: If you choose, ask four volunteers to act out the role play. As the trainer, you can read the introduction. After reading the role play, allow 3 to 5 minutes for open discussion.

106 Healthy Heart, Healthy Family: A Community Health Worker’s Manual for the Filipino Community

The family helped Ric learn that he has to make some changes to lower his high blood pressure and lower his risk of a stroke.

• Ask:

• What are some of the lessons we learned from this role play?

• Is there any part of the play that you can use in your own life?

• Give the following responses if they are not said:

Jose teaches Ric that:

• High blood pressure often does not have symptoms and is called the

“silent killer.”

• Changing his diet and level of physical activity can help Ric control or lower

his high blood pressure and reduce his risk of a stroke.

• Jose’s friends made the right decision by calling 9–1–1 right away when he

showed signs of a stroke.

6. Nutrition Facts Label Activity––Sodium

One way Lola has learned to control her high blood pressure is by reading the Nutrition Facts label on food products.

• Show picture card 4.7.

The Nutrition Facts label found on packaged foods is one of the best tools we have for choosing foods for a healthy diet. In this session, we will learn how to use the Nutrition Facts label to choose foods that are lower in sodium.

• Give group members the “Read the Nutrition Facts Label for Sodium!” handout (page 128).

Session 4. Help Your Heart: Control Your High Blood Pressure 107

The Nutrition Facts label lists the serving size and number of servings in the container. It also gives the amount of calories, sodium, saturated fat, trans fat, and cholesterol in one serving of the food. We will talk about calories, saturated fat, trans fat, and cholesterol in the next two sessions. Today, we will concentrate on sodium.

• Point to where the Percent Daily Value is located on the Nutrition Facts label.

The Percent Daily Value helps you compare products. It tells you if a food is high or low in various nutrients. Remember—it is easy to take in more than 2,300 milligrams of sodium. Choose foods with a lower Percent Daily Value for sodium. A Percent Daily Value of 5 or less is low, and a Percent Daily Value of 20 or more is high. Once you get into the habit of looking at Nutrition Facts labels, it will be easy.

More Asian grocery stores are now carrying products with Nutrition Facts labels, making it easier to choose foods, sauces, and seasonings that are lower in sodium.

Let’s take a close look at the nutrition facts on an actual label to find the amount of sodium. Let’s go back to the “Read the Nutrition Facts Label for Sodium!” handout.

• Point again to picture card 4.7.

The Percent Daily Value for sodium in frozen peas and carrots is circled on the Nutrition Facts label.

108 Healthy Heart, Healthy Family: A Community Health Worker’s Manual for the Filipino Community

The sodium content of the same food can vary depending on how it is packaged or what brand it is. Compare Nutrition Facts labels to choose foods that are lower in sodium.

Look at the bottom of the handout. Look at the Percent Daily Value for frozen peas and carrots and for canned peas and carrots. Which peas and carrots are lower in sodium?

Frozen peas and carrots are lower in sodium. One serving of frozen peas and carrots has only 5 percent of the Daily Value for sodium. One serving of canned peas and carrots has 15 percent of the Daily Value for sodium. In other words, the canned peas and carrots have three times more sodium than frozen peas and carrots. Rinsing the canned peas and carrots in cold water can help reduce the sodium content.

More Information: Potassium, Calcium, and Magnesium

The latest research shows that foods rich in potassium are important in protecting against high blood pressure. Foods rich in calcium and magnesium may help, too.

Good Sources of Potassium, Calcium, and Magnesium:

• Potassium: bananas, plantains, papayas, oranges, prunes, tomatoes, potatoes,

spinach, and dry beans

• Calcium: low-fat milk; low-fat, reduced-sodium cheese; low-fat yogurt;

calcium-fortified orange juice; leafy greens; and fresh or rinsed canned fish

• Magnesium: whole-grain breads and cereals, oatmeal, brown rice, beans,

nuts, seeds, okra, and spinach

Session 4. Help Your Heart: Control Your High Blood Pressure 109

One eating plan that can lower blood pressure is Dietary Approaches to Stop Hypertension (DASH). By using the DASH plan, you can lower your blood pressure by eating:

• Lots of fruits and vegetables • Fat-free or low-fat milk products • Whole-grain products • Fish, poultry, and lean meats • Nuts, seeds, and dry beans

The DASH eating plan also includes:

• Less salt and sodium • Small amounts of fats and oils • Small amounts of sweets and beverages that are high in sugar

People with high blood pressure will get extra benefits from following the DASH eating plan and eating foods low in salt and sodium. This combination is also heart healthy for people who do not have high blood pressure.

Choosing and preparing foods that are lower in salt and sodium may help prevent or lower high blood pressure. Eating more fruits and vegetables, wholegrain breads and cereals, and fat-free or low-fat milk products, or fat-free or low-fat lactose-free products, also may help lower blood pressure.

Let’s try an activity that will help us choose foods that are low in salt and sodium. First, I am going to describe a situation that may apply to you or to a member of your family. Then, using Nutrition Facts labels, we are going to learn how to choose lower-sodium foods.

110 Healthy Heart, Healthy Family: A Community Health Worker’s Manual for the Filipino Community

• Give each group member the “Ric’s Food Choices” handout (pages 129–131). Read or ask a volunteer to read the story below.

Ric’s Food Choices

Ric’s blood pressure was slightly higher the last time he visited his doctor. The doctor told him to cut back on the amount of sodium he eats. Use the Nutrition Facts labels to help Ric choose foods that will help him follow his doctor’s advice.

Let’s go over some questions. Use the Nutrition Facts labels to choose the foods that are lower in sodium.

• Ask these questions. Give the correct answer after group members guess.

Questions Pineapple juice

When buying juice, should Ric choose tomato juice or pineapple juice? Light soy sauce

Should Ric buy soy sauce or light soy sauce? Dry roasted peanuts, unsalted

Should Ric eat unsalted dry roasted peanuts or beef jerky? Chicken siopao

Should Ric eat regular canned pork or chicken siopao? Low-sodium crackers

Should Ric snack on pork rinds or lowsodium crackers?

Session 4. Help Your Heart: Control Your High Blood Pressure 111

7. Shake the Salt and Sodium Habit

• Give group members the “Sodium in Foods” handout (pages 132–133).
• Ask:

Does anyone see a food on the right side of the page that you eat often?

• Ask the person to name a lower-sodium food on the left side that he or she could eat instead.

Let’s now review some practical tips that will help you cut back on salt and sodium.

• Give each group member a copy of the “Keep Your Heart in Mind: Lola’s Tips To Eat Less Salt and Sodium” handout (pages 134– 135). Review the tips on how to cut back on salt and sodium when shopping, cooking, and eating.

Here is Lola’s favorite tip to control high blood pressure. Gradually decrease the sodium in your diet, and cook with seasonings and sauces that are low in sodium.

• Ask:

Why is it hard for you to cut back on salt and sodium?

Note: Allow 3 minutes for group members to respond. Write their responses on the blackboard or on a large piece of paper taped to the wall. Then write down some possible solutions. See the “Examples” box for some problems and solutions.

112 Healthy Heart, Healthy Family: A Community Health Worker’s Manual for the Filipino Community

Salt Solutions Examples

Problems You May Encounter Solutions

Using fewer traditional sauces or When preparing foods, use a smaller seasonings is difficult. amount of the sauces and seasonings that are high in sodium. Replace some with light versions, such as light soy sauce, which has less sodium.

The food has no flavor. Use herbs and spices to add flavor to foods. See the “Use Herbs and Spices Instead of Salt” handout (page 138).

Family members will get upset. Cut back on salt slowly. Use less salt each time you cook, so family members can get used to the taste.

Adding salt is a hard habit to break. Give yourself time to get used to using less salt. Choose brands that are lower in salt. Take the saltshaker off the table.

8. Easy on the Alcohol

Drinking too much alcohol can raise your blood pressure. It can also harm the liver, brain, and heart. Alcoholic drinks also contain calories. The extra calories can make it hard to control your weight.

If you do not drink alcohol, don’t start. If you drink alcohol, drink only a moderate amount. That means:

• Men should have no more than two drinks a day.

• Women should have no more than one drink a day.

• Pregnant women should not drink any alcohol.

Session 4. Help Your Heart: Control Your High Blood Pressure 113

• Ask:

What do you think counts as one drink?

Note: Allow a few minutes for group members to respond.

One drink is:

• 12 ounces of beer (regular—150 calories, light—100 calories)

• 5 ounces of wine (100 calories)

• 1½ ounces of liquor (100 calories)

9. Manage Your Blood Pressure With Medicine

Note: The general term “medicine” refers to Western medicine.

If you have high blood pressure, making the lifestyle changes we just discussed may not be enough to lower your blood pressure. Medications are available to lower blood pressure. They work in different ways.

• Give group members the “Tips for Taking Medicine for High Blood Pressure” handout (pages 136–137).
• Ask:

Do any of you take medicines for high blood pressure?

114 Healthy Heart, Healthy Family: A Community Health Worker’s Manual for the Filipino Community

• Read aloud the “Tips for Taking Medicine for High Blood Pressure” handout.
• Ask:

If you are taking medication for high blood pressure, what are some things you can do to help your medicines work better?

Note: Allow a few minutes for group members to respond.

• Add the following suggestions if they are not mentioned:

• Ask your doctor the name of your medicine and how to take it.

• Take your medicine the way the doctor tells you.

• Tell your doctor the names of all other medicines, home remedies, herbs,

supplements, or any traditional Asian medicine you take.

• Tell your doctor if the medicine makes you feel strange or sick.

• Refill your prescription before you run out of medicine.

• Have your blood pressure checked to see if the medicine is working for you.

• Keep taking the medicine as your doctor tells you, even if your blood

pressure is okay.

Some people use traditional medicine or home remedies instead of or in addition to Western medicine. Tell your doctor if you are using traditional Asian medicine or home remedies. The doctor needs to know if you are taking anything that does not work well with your prescribed medicine(s).

Session 4. Help Your Heart: Control Your High Blood Pressure 115

More Information

Medicine for High Blood Pressure

• Many people with high blood pressure take more than one medicine to keep

their blood pressure low.

• Some medicines can cause side effects or reactions. If this happens, talk to

your doctor.

• Eating more fruits and vegetables, cutting back on salt and sodium, starting an

eating pattern of low saturated fat and low cholesterol, losing weight, and being physically active can help your medicines work better.

10. Fish Cardillo Recipe

• Give group members the “Use Herbs and Spices Instead of Salt” handout (page 138). Ask them to use some of the herbs and spices in place of salt when they cook this week.
• Give group members the “Fish Cardillo Recipe” handout (page 139). Ask them to prepare it during the coming week. Tell them that using this recipe will give them a chance to practice some of the ideas from the session.

Review of Today’s Key Points

Let’s review what we learned today.

What is blood pressure?

• Blood pressure is the force of blood against the walls of your arteries. Blood

pressure is necessary to move blood through your body.

116 Healthy Heart, Healthy Family: A Community Health Worker’s Manual for the Filipino Community

What is a normal blood pressure?

• A normal blood pressure is below 120/80 mmHg.

What is prehypertension?

• Blood pressure of 120/80 to 139/89 mmHg is prehypertension. This means

that you do not have high blood pressure yet, but you’re likely to develop it in the future unless you make changes in your health habits.

What is high blood pressure?

• High blood pressure is 140/90 mmHg or greater. Have your blood pressure

checked. If it is 140/90 mmHg or greater, see your doctor.

Why is high blood pressure dangerous?

• High blood pressure can lead to heart attack, stroke, kidney problems, eye

problems, and death.

What can you do to help make your blood pressure medicine work better?

• Eat more fruits and vegetables, cut back on salt and sodium, lose weight,

and be more physically active. Take your medicine as your doctor tells you. Talk to your doctor about side effects.

Why should you cut back on salt and sodium in your food?

• You should cut back on salt and sodium to help prevent or lower high

blood pressure.

What are some ways to cut back on salt and sodium?

• Use herbs and spices to season foods. Be careful! Some seasonings such as

garlic salt and onion salt are high in sodium. Check the Nutrition Facts label to choose foods lower in sodium. Eat more fruits and vegetables for snacks instead of salty snacks such as nuts, pretzels, or chips.

How can drinking alcohol affect your blood pressure?

• Drinking too much alcohol can raise blood pressure.

Session 4. Help Your Heart: Control Your High Blood Pressure 117

What is a stroke?

• A stroke occurs when blood suddenly stops going to the brain. This can

happen for different reasons. One reason is that a blood vessel bursts. Another is that a clot blocks the arteries. Either way, the result is the same: blood stops going to the brain, and brain cells die. Both types of stroke are very serious and can lead to disability and death.

What is another name for a stroke?

• A stroke is also called a brain attack.

Lola’s Life Lessons: A Time To Reflect

In the last session, Lola Idad reminded us that setting goals and not giving up can help us make the necessary lifestyle changes. Perseverance must be combined with an awareness of your actions. It requires you to look at your habits and to plan for the future.

You have learned a lot today about how to prevent and control high blood pressure. You also learned how to cut back on salt and sodium. Now let’s think about how you can practice what you have learned. Please think of one change you can make in your everyday life.

Be specific about what you plan to do, how you plan to do it, and when you will start. Here are some examples:

• I will get my blood pressure checked within the next month.

• I will read Nutrition Facts labels the next time I go to the store to help me

choose canned vegetables that are lower in sodium, or I will prepare fresh or frozen vegetables without adding salt.

118 Healthy Heart, Healthy Family: A Community Health Worker’s Manual for the Filipino Community

• I will rinse canned foods with water before I cook or eat them,

starting tomorrow.

• I will take the saltshaker off the table, starting tomorrow.

• Give each group member the “Lola’s Life Lessons: Session 4” handout (page 140).
• Ask a volunteer to read the handout.

Please take a few moments to reflect on Lola’s advice and how it applies to your life. At the bottom of the handout, there is a space called “A Time To Reflect.” Use this section to record your feelings about this week’s session. Please write down your thoughts. Remember, this is for you and no one else.

• Give each group member 2 to 3 minutes to write down some thoughts.

Pledge for Life!

• Give each group member the “Pledge for Life! Session 4” handout (page 141).

Take the pledge for life with Lola Idad. Lola and her family have taken the pledge to practice heart healthy eating daily. Take the step toward healthy eating and lowering your blood pressure. Pledge to do one thing on this list during the coming week. Now, let’s start by sharing our goals with each other.

Would anyone like to share his or her pledge with the group?

Note: Write down pledge ideas on the blackboard or on a large piece of paper taped to the wall.

Session 4. Help Your Heart: Control Your High Blood Pressure 119

We will talk about how you did with your pledges at the next session. Remember to keep working on your pledges to be more physically active.

Blood Pressure Check

(Optional—Try to get a health professional to come to your session.)

• Tell group members that a health professional will now check everyone’s blood pressure.
• Ask group members to write their blood pressure numbers on the “My Healthy Heart Wallet Card” handout.

Closing

Thank you for coming today. What did you think of today’s session?

Note: Wait to see if group members respond.

I am looking forward to seeing you at the next session. The next session will be about how to prevent and control high blood cholesterol.

Note for Educator: Think about today’s session. What worked and what didn’t work? Have you decided to make any changes in your own lifestyle based on what was covered in today’s session to control or prevent high blood pressure?

120 Healthy Heart, Healthy Family: A Community Health Worker’s Manual for the Filipino Community

Know the Warning Signs of a Stroke. Act Quickly.

A stroke happens when blood suddenly stops going

Brain Eyes

to the brain and brain cells die. A stroke is very

Face

serious and can lead to disability and death.

Signs of a stroke: Arm

• Numbness of the face, arm, or leg (especially on one side of the body)
• Confusion, trouble talking, and difficulty understanding others
• Trouble seeing in one or both eyes Leg
• Trouble walking, dizziness, and loss of balance or coordination
• Severe headache

A Stroke Is Serious. Every Second Counts.

• Learn the warning signs of a stroke, and teach them to your family

and friends.

• Call 9–1–1 immediately if you have any of these stroke warning signs.

• Treatment can reduce the risk of damage from a stroke. You must get help

within 3 hours of your first symptoms.

Adapted from the American Stroke Association, “Let’s Talk About Risk Factors for Stroke,” 1999–2003. A division of the American Heart Association.

HANDOuT—SESSION 4 121

Alamin ang Mga Senyales ng Babala ng isang Stroke. Kumilos Kaagad.

Nangyayari ang isang stroke kapag biglang tumigil ang pagpunta ng dugo sa utak, at mamamatay ang mga selula

Utak Mata

sa utak. Ang isang stroke ay napakaseryoso at maaaring

Mukha

humantong sa pagkabaldado at pagkamatay.

Braso

Mga Senyales ng Isang Stroke:

• Pamamanhid ng mukha, braso, o binti (lalo na sa isang bahagi ng katawan)
• Pagkalito, problema sa pagsasalita, at paghihirap sa pag-unawa sa iba

Binti

• Problema sa pagtingin sa isang mata o kapwa mga mata
• Problema sa paglalakad, pagkahilo, at kawalan ng balanse o koordinasyon
• Matinding sakit ng ulo

Seryoso ang Isang Stroke. Ang Bawat Sandali ay Mahalaga.

• Alamin ang mga senyales ng babala ng isang stroke, at ituro ang mga ito sa iyong pamilya at mga kaibigan.
• Tumawag kaagad sa 9–1–1 kung mayroon kang alinman sa mga senyales ng babala ng stroke.
• Maaaring mabawasan ng paggagamot ang peligro ng pinsalang dulot ng isang stroke. Dapat kang humingi ng tulong sa loob ng 3 oras ng iyong unang sintomas.

Alinsunod sa American Stroke Association, “Let’s Talk About Risk Factors for Stroke,” 1999–2003. Isang dibisyon ng American Heart Association.

122 HANDOuT—SESSION 4

Stroke Survival Tips

• Know the symptoms of a stroke. This can help you act quickly if you feel ill.
• Keep a card with emergency numbers and a list of your medications with you at all times. The information will allow emergency medical personnel to contact your doctor, a friend, or a relative who can provide information on medications you are taking.
• Keep a phone on a low table. This will help you if you fall during a stroke or are unable to walk to a telephone and call for help.
• Keep a clock in the bedroom, living room, and kitchen, or wear a watch. If you think you are having a stroke, check the time so you will know when the first symptom appeared.
• Place a pad and pen on your nightstand with a checklist of medicines. Keep your checklist of medicines updated. If you have a stroke, tell emergency medical personnel where to find the list. This will help the health professionals know how best to treat you.
• Give a spouse, family member, or neighbor a list of the warning signs of a stroke and your emergency numbers. They may be able to help you if you have a stroke or provide important information to emergency medical personnel.

Adapted from the National Council on Aging’s “Stroke Survival Tips,” 2003.

HANDOuT—SESSION 4 123

My Healthy Heart Wallet Card

"

Check your:

"

Talk to your doctor about what these numbers mean!7% or lessA1CLess than 100Blood glucoseBlood tests to check sugar in the blood for diabetesWomen: 35 inches or lessMen:Waist measurementsWeight

40 inches or less

(fasting)

ValueDateValueDate ValueDateValueDate

blood pressure, blood cholesterol, weight, waist measure, and blood glucose

_____________________________________

Name

(FOLD 1)

Take Care of Your Heart

(FOLD 2)

fat, cholesterol, and sodium trans

d and

fruits, vegetables, whole grains, and fat-free or low-fatmilk productsweight and waist measure

+ + physical activity– calories, saturate–0 cigarettes= A healthy heart

Less than 150 mg/dLTriglyceridesMore than 40 mg/dLHDLLess than 130 mg/dL—Less than 100 mg/dL—idealLDLLess than 200 mg/dLTotal CholesterolLess than 120/80 mmHgBlood Pressure near ideal

Blood tests to measure fats in the blood

ValueDateValueDate ValueDateValueDate ValueDate

Try these tips for a healthy heart!

Cut along dotted lines. Fold the card in half and paste with a glue stick (fold 1).Fold in half again to make your own personal wallet card (fold 2).

Front "

Back "

SESSION

Take Steps—Healthy Habits To Lower High Blood Pressure!

To prevent high blood pressure:

1. Maintain a healthy weight.

Try not to gain extra weight. Lose weight if you are overweight. Try losing weight slowly, about 1 to 2 pounds (0.45 to 0.91 kilogram) each week until you reach a healthy weight.

1. Be active every day for at least 30 minutes.

You can walk, dance, play sports, or do any activity you enjoy.

1. Eat less salt and sodium.

Buy foods marked “sodium free,” “low sodium,” or “reduced sodium.” Take the saltshaker off the table.

1. Eat more fruits and vegetables, whole-grain breads and cereals, and fat-free or low-fat milk products.
2. Cut back on alcohol.

Men who drink should have no more than one or two drinks each day. Women who drink should have no more than one drink a day. Pregnant women should not drink any alcohol.

To lower high blood pressure:

1. Practice these steps:

• Maintain a healthy weight. • Be physically active every day for

at least 30 minutes.

• Eat fewer foods and sauces high in

salt and sodium.

• Eat more fruits and vegetables,

whole-grain breads and cereals, and fat-free or low-fat milk products.

• Cut back on alcoholic beverages.

1. Take your medicine the way your doctor tells you.
2. Have your blood pressure checked often.

SESSION

Role Play: Lola’s Family Works Together To Control High Blood Pressure

Mila and Cesar are getting ready for bed. They are discussing Mila’s younger brother, Ric, who lives with them and recently visited the doctor’s office.

Cesar: Ric finally went to Dr. Cabaya for his annual checkup and found out that he has high blood pressure! The doctor told Ric that he has to eat fewer salty foods and become more physically active. I tried to tell him to follow Dr. Cabaya’s advice, but he said he feels fine. He just does not want to change.

Mila: Do you think it would help him to talk to your brother Jose? Since his stroke, Jose has changed his eating habits and started walking regularly. Even he had a hard time getting started … and he is a nurse!

Cesar: That’s a good idea. Ric may listen to him. Let’s invite Jose and his family over for dinner.

Later that week, Jose and his family have dinner with Cesar, Mila, and Ric. Jose and Ric are talking before dinner.

Ric: Kuya* (“elder brother”), I hate going to the doctor. They always find something wrong! Now I have to eat foods low in sodium and do physical activity to control my high blood pressure. That makes no sense! I do not understand why I should be so concerned about this now. I feel fine.

Jose: It doesn’t matter how you feel or look. Many people do not have symptoms when they have high blood pressure. That is why it is called the “silent killer.”

Ric: Silent killer? What do you mean? I am strong.

• It is common to address an older gentleman for whom you have a lot of respect as “Kuya,” whether he is blood related or not.

126 HANDOuT—SESSION 4

Role Play: Lola’s Family Works Together To Control High Blood Pressure (continued)

Jose: It means that it can go undetected if you do not have it diagnosed by a health professional and try to lower it to within the normal range. Look, I am a nurse and even I did not try to lower my high blood pressure. Then I had a stroke, remember? I am lucky that my friends recognized the signs of a stroke and called 9–1–1 right away.

If I had lowered my blood pressure earlier, my chances of having the stroke would have been much lower. I wish I had not had the stroke, but it was a big wake-up call.

Ric: Yes, that was scary. I was surprised, because you are only 5 years older than I am. But I am not too heavy. I play basketball all the time.

Jose: Ric, that is good. Then you should make those changes to your lifestyle. Maybe you could lose a little weight––I have lost 20 pounds (9 kilograms) since I got serious about lowering my blood pressure. I also take blood pressure medicine as my doctor prescribes.

Ric: Okay, okay, okay. I see I need to make the changes now. Thanks, Kuya!

Jose: Let’s eat. Mila made her fish cardillo.

HANDOuT—SESSION 4 127

Read the Nutrition Facts Label for Sodium!

Nutrition Facts labels tell you what you need to know about choosing foods that are lower in sodium. Here is a Nutrition Facts label for frozen peas and carrots.

Frozen Peas and Carrots

Nutrition Facts

Serving Size ½ cup (121g) Servings Per Container 3

Amount Per Serving

Amount Per Serving

Calories 50 Calories from Fat 0

The nutrient amounts are for

% Daily Value*

one serving. So, if you eat more or less than a serving, Total Fat 0g 0% you need to add or subtract Saturated Fat 0g 0% nutrient amounts. For Trans Fat 0g example, if you eat 1 cup Cholesterol 0mg 0% of peas and carrots, you are Sodium 125mg 5% eating two servings.

Total Carbohydrate 9g 3% Dietary Fiber 3g 12%

Nutrients Sugars 4g

Protein 2g

Listed are the amounts of sodium in one serving. Vitamin A 35% • Vitamin C 6% These amounts are given in Calcium 2% • Iron 2% milligrams (mg).

The Choice Is Yours— Calories 50 Calories from Fat 0 Compare!

% Daily Value* Total Fat 0g 0%

Which one would Saturated Fat 0g 0%

Trans Fat 0g

you choose?

Cholesterol 0mg 0% Sodium 125mg 5%

Frozen peas and carrots are lower in sodium than canned.

Calories 60 Calories from Fat 0

Read the labels, and choose foods that are lower in sodium % Daily Value*

Total Fat 0g 0%

to help keep your heart strong.

Saturated Fat 0g 0% Trans Fat 0g Cholesterol 0mg 0% Sodium 360mg 15%

Serving Size and Number of Servings

The serving size is ½ cup. The package contains about three servings. Remember, the numbers on the label are for one serving, not the whole container.

Percent Daily Value

The Percent Daily Value helps you compare products and quickly tells you if the food is high or low in sodium. Choose products with the lowest Percent Daily Value for sodium: 5 percent or less is low, and 20 percent or more is high.

Frozen Peas and Carrots One serving (½ cup) of frozen peas and carrots has 125 mg of sodium and 5 percent of the Daily Value for sodium.

Canned Peas and Carrots One serving (½ cup) of canned peas and carrots has 360 mg of sodium and 15 percent of the Daily Value for sodium. That is almost three times the sodium found in a serving of frozen peas and carrots.

are based on a 2,000-calorie diet. Your Daily Values may be higher or lower depending on your calorie needs.

128 HANDOuT—SESSION 4

Ric’s Food Choices

Ric’s blood 1 – Tomato Juice pressure was

Nutrition Facts

slightly higher

Serving Size ¾ cup (177 ml)

the last time Servings Per Container 1 he visited his

Amount Per Serving

doctor.

Calories 30 Calories from Fat 0

The doctor told

% Daily Value*

him to cut back

Total Fat 0g 0%

on the amount

Saturated Fat 0g 0%

of sodium he

Trans Fat 0g

eats. Cholesterol 0mg 0%

Sodium 660mg 27% Lower

Use the

Total Carbohydrate 7g 2% sodium

Nutrition Facts Dietary Fiber 0g 0%

choice

labels to help Sugars 6g

___ Protein 1g

Ric choose foods that will

Vitamin A 6% • Vitamin C 0%

help him follow

Calcium 0% • Iron 5%

his doctor’s advice.

Write the 3 – Soy Sauce number of your

Nutrition Facts

choice for each

Serving Size 1 Tablespoon

pair in the space Servings Per Container 20 between the

Amount Per Serving

labels.

Calories 10 Calories from Fat 0

% Daily Value*

Total Fat 0g 0% Saturated Fat 0g 0% Trans Fat 0g

sodium Dietary Fiber 0g 0% choice Sugars 0g ___ Protein 2g

Vitamin A 0% • Vitamin C 0% Calcium 0% • Iron 0%

2 – Pineapple Juice

Nutrition Facts

Serving Size ¾ cup (177 ml) Servings Per Container 1

Amount Per Serving

Calories 85 Calories from Fat 0

% Daily Value*

Total Fat 0g 0% Saturated Fat 0g 0% Trans Fat 0g

Sugars 20g Protein 1g

Vitamin A 0% • Vitamin C 100% Calcium 2% • Iron 2%

4 – Light Soy Sauce

Nutrition Facts

Serving Size 1 Tablespoon Servings Per Container 20

Amount Per Serving

Calories 10 Calories from Fat 0

% Daily Value*

Total Fat 0g 0% Saturated Fat 0g 0% Trans Fat 0g

Sugars 0g Protein 1g

Vitamin A 0% • Vitamin C 0% Calcium 0% • Iron 0%

are based on a 2,000-calorie diet. Your Daily Values may be higher or lower depending on your calorie needs.

HANDOuT—SESSION 4

Ric’s Food Choices

5 – Dry Roasted Peanuts, Unsalted

Nutrition Facts

Serving Size 1 oz Servings Per Container 16

Amount Per Serving

Calories178 Calories from Fat 130

% Daily Value*

Total Fat 14g 22% Saturated Fat 2g 10% Trans Fat 0g

Sugars 1g Protein 8g

Vitamin A 2% • Vitamin C 0% Calcium 8% • Iron 0%

7 – Canned Pork, Regular

Nutrition Facts

Serving Size 2 ounces (56g) Servings Per Container 1

Amount Per Serving

Calories180 Calories from Fat 140

% Daily Value*

Total Fat 16g 25% Saturated Fat 6g 30% Trans Fat 0g

Sugars 0g Protein 8g

Vitamin A 0% • Vitamin C 0% Calcium 0% • Iron 2%

6 – Beef Jerky

Nutrition Facts

Serving Size 1 ounce Servings Per Container 4

Amount Per Serving

Calories 80 Calories from Fat 10

% Daily Value*

Total Fat 1g 2% Saturated Fat 0g 0% Trans Fat 0g Cholesterol 25mg 8% Sodium 460mg 19% Lower Total Carbohydrate 6g 2% sodium Dietary Fiber 0g 0% choice Sugars 4g ___ Protein 10g

Vitamin A 0% • Vitamin C 0% Calcium 0% • Iron 6%

8 – Chicken Siopao (Steamed Bun With Chicken Filling)

Nutrition Facts

Serving Size 1 Tablespoon Servings Per Container 20

Amount Per Serving

Calories 10 Calories from Fat 0

% Daily Value*

Total Fat 0g 0% Saturated Fat 0g 0% Trans Fat 0g Cholesterol 0mg 0% Lower Sodium 600mg 25% Total Carbohydrate 0g 0% sodium Dietary Fiber 1g 8% choice Sugars 0g ___ Protein 1g

Vitamin A 0% • Vitamin C 0% Calcium 0% • Iron 0%

are based on a 2,000-calorie diet. Your Daily Values may be higher or lower depending on your calorie needs.

HANDO

Ric’s Food Choices

9 – Pork Rinds

Nutrition Facts

Serving Size 1 ounce (15g) Servings Per Container 7

Amount Per Serving

Calories 80 Calories from Fat 45

% Daily Value*

Total Fat 5g 8% Saturated Fat 1.5g 8% Trans Fat 0g

Sugars 0g Protein 8g

Vitamin A 2% • Vitamin C 0% Calcium 0% • Iron 2%

10 – Crackers, Low Sodium

Nutrition Facts

Serving Size 5 crackers Servings Per Container 32

Amount Per Serving

Calories 60 Calories from Fat 10

% Daily Value*

Total Fat 1g 2% Saturated Fat 0g 0% Trans Fat 0g Cholesterol 0mg 0% Lower Sodium 35mg 2% Total Carbohydrate 10g 3% sodium Dietary Fiber 1g 4% choice Sugars 0g ___ Protein 1g

Vitamin A 0% • Vitamin C 4% Calcium 2% • Iron 4%

are based on a 2,000-calorie diet. Your Daily Values may be higher or lower depending on your calorie needs.

T

Sodium in Foods

Choose MORE Often

Foods LOWER in Sodium

• Low-sodium sauces, such as light soy

sauce

• Chicken and turkey (with skin

removed)

• Fresh seafood or rinsed

canned fish, such as tuna* or sardines

• Canned foods packed in water

• Low-sodium or reduced-sodium

cheeses

• Low-salt chips, nuts,

seeds, and crackers

• Plain noodles (pasta) or steamed rice

• Homemade, low-sodium, or reduced-

sodium soups

• Fresh, frozen, “no-salt-added,” or rinsed

canned† vegetables

• Spices, herbs, and flavorings, such as

bay leaf, green onion or onion powder, fresh garlic or garlic powder, saffron, ginger, lemongrass, parsley, tamarind leaf, vinegar, and watercress

Choose LESS Often

Foods HIGHER in Sodium

• Balut (fertilized egg)

• Smoked and cured meats,

such as bacon, ham, sausage, hotdogs, and bologna

• Canned seafood,* such as tuna,

sardines, and squid (that are not rinsed†)

• Canned meat, such as pork, corned

beef, and sausage

• Canned foods packed in broth or salt†

• Most cheeses

• Salty chips, crackers, nuts, and

pretzels

• Quick-cooking rice and boxes of

mixed rice, potatoes, or noodles

• Regular canned and instant soups

• Regular canned vegetables and

pickled vegetables†

• Condiments and seasonings, such as

soy sauce, monosodium glutamate (MSG), fish sauce, salted shrimp paste, salty, dried fish, dried salty shrimp, dried squid, ketchup, garlic salt, seasoning salt, bouillon cubes, and meat tenderizer

Pregnant and nursing mothers: Talk to your health care provider to find out the types of fish you can eat that are lower in mercury. † Rinse canned foods to reduce the sodium.

u

Asin sa Mga Pagkain

Piliin nang MAS Madalas ng Mga Pagkaing MAS MABABA ang Asin

• Mga sarsang mababa sa asin, tulad ng light

na toyo

• Manok at pabo (na tinanggalan ng balat) • Sariwang pagkaing dagat o binanlawang de

latang isda, tulad ng tuna,* o mga sardinas

• Mga de latang pagkaing inihanda sa tubig • Mga kesong mababa sa asin o bawas na asin • Mga low-salt sitsirya, nut, buto, at

biskwit

• Walang sangkap na mga noodle (pasta) o

sinaing na kanin

• Gawang-bahay, mababa sa asin, o mga sopas

na bawas ang asin

• Sariwa, nai-freeze, “walang idinagdag na

asin,” o mga binanlawang de latang† gulay

• Mga pampalasa, herbs at panimpla, tulad ng

laurel, berdeng sibuyas o pulbos na sibuyas, sariwang bawang o pulbos na bawang, saffron, luya, tanglad, parsley, dahon ng sampalok, suka, at watercress

• Ang ilang mga uri ng isda ay naglalaman ng mataas na antas ng

Piliin nang HINDI Gaanong Madalas ang Mga Pagkaing MAS MATAAS sa Asin

• Balut (binugok na itlog) • Pinausukan at ibinabad na mga karne

tulad ng bacon, hamon, longanisa, mga hotdog, at bologna

• De latang pagkaing dagat,* tulad ng tuna,

sardinas, at pusit (na hindi nababanlawan)†

• De latang karne, tulad ng baboy, karne norte,

at longanisa

• Mga de latang pagkaing naipaketeng may

broth o asin†

• Karamihang mga keso • Mga maaalat na sitsirya, biskwit, nut,

at pretzel

• Mabilis malutong kanin at nakakahong may

halong kanin, patatas, o pansit

• Regular na de lata at mga instant na sopas • Regular na de latang mga gulay at

inatsarang gulay†

• Mga sawsawan at pampalasa, tulad ng toyo,

betsin (monosodium glutamate, MSG), patis (sawsawang gawa sa isda), alamang (pinaalat na hipong sawsawan), tuyo (maalat, tuyong isda), hibi (pinatuyong maalat na hipon) o pusit (pinatuyong pusit), ketchup, asing bawang, pampalasang asin, mga bouillon cube, at pampalambot ng karne

mercury. Dapat iwasan ang ganitong uri ng isda ng mga buntis na kababaihan at nagpapasusong ina. Para sa karagdagang impormasyon, tingnan ang www.cfsan.fda.gov/~dms/admehg3.html. Banlawan ang mga de latang pagkain upang mabawasan ang dami ng asin.

SESSION

Keep Your Heart in Mind: Lola’s Tips To Eat Less Salt and Sodium

Do you know your blood pressure numbers?

• A normal blood pressure is below 120/80 mmHg. • If your blood pressure is between 120/80 and 139/89 mmHg, you have

prehypertension. This means that you do not have high blood pressure yet, but you are likely to develop it if you don’t change your health habits.

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

hypertension. High blood pressure does not go away by itself. Ask your doctor for help in lowering it.

• Ask your doctor what your blood pressure is. Keep track of each reading on your

wallet card.

Write down your blood pressure reading here:

______/_____

Spice it up!

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

My family got used to foods with

Lola Idad has learned less salt when I learned to use fewer

high-sodium sauces and add less

that it is not hard to

salt to my foods. Now, I make food

get your family to eat taste good by using vinegar, bay

leaf, green onion, garlic, ginger,

less salt and sodium. saffron, tamarind, lemongrass, and

even a dash of hot pepper. If I need some patis (fish sauce) or bagoong

Look for low-sodium alamang (salted shrimp paste) for

the sauce, then I use only a small

or salt-free seasonings

amount of it.

and sauces in the grocery store.

134 HANDOuT—SESSION 4

(continued)

Take the lead and try these simple changes:

When Shopping

1. Buy fresh, frozen, or no-salt-

added canned vegetables. Choose food packed in water instead of broth or salt.

2. Buy fresh garlic or

garlic powder instead of garlic salt.

3. Choose foods labeled “low

sodium,” “lite,” “light,” “sodium free,” or “no salt added.”

When Cooking

1. Slowly cut back on the amount of

salt added when cooking until you do not use any.

2. Reduce the amount of high-sodium

sauces, paste, and seasonings. Add no salt to the water when

3.

cooking beans, rice, noodles, and vegetables. Cut back on smoked, cured, and

4.

processed beef, seafood, poultry, and pork, such as ham, sausage, and corned beef. Rinse all canned products to

5.

reduce the amount of sodium.

When Eating

1. Fill the saltshaker with

a mixture of herbs and spices instead of salt.

2. Slowly cut back on the

amount of salt added at the table until you don’t use any.

3. Choose fruits and vegetables

instead of salty snacks such as chips, fries, and pork rinds.

4. Cut back on sauces that have a lot

of sodium, like bagoong (salted fish paste) and patis (fish sauce).

Ric has learned to control his high blood pressure. He takes his blood pressure pills with breakfast every morning to make sure that he does not forget to take them. He walks daily, has stopped smoking, and has found that food can still taste good with less salt and sodium.

Make your personal pledge to do what Ric has done! Look at these examples:

Breakfast

Cook oatmeal with fat-free or low-fat (1%) milk or soy milk, raisins, cinnamon, and no salt.

Lunch

Use leftover roast beef to make a sandwich instead of using lunch meats, or have beef with leftover rice and vegetables.

Dinner

Make your own fish cardillo with vegetables and half the usual amount of salt.

Snack

Eat a mango instead of salty chips.

Write the changes you will try to make this week:

Your health and your family’s health are priceless. Value it!

HANDO

Tips for Taking Medicine for High Blood Pressure

1. Make sure you take your medicine every day as your doctor tells you, not only on the days when you do not feel well.
2. Tell the doctor the names of all other medicines, home remedies, herbs, or supplements you take. Bring everything with you when you have a doctor’s appointment.
3. Tell the doctor right away if the medicine makes you feel strange or sick. Ask the doctor about changing the dosage or switching to another type of medicine.
4. Refill your prescription before you run out of medicine.
5. Have your blood pressure checked often to see if the medicine is working for you.
6. Do not stop taking your medicine if your blood pressure is okay. That means the medicine is working.

Questions To Ask the Doctor:

When the doctor gives you medicine for high blood pressure, ask:

What is the name of the medicine(s)? ___________________________________

How much of each medicine should be taken? ____________________________

When should the medicine(s) be taken?__________________________________

What may be eaten or drunk with the medicine(s)?_________________________

Can other medicines be taken safely at the same time?______________________

_________________________________

What number should be called immediately if problems occur?_______________

136 HANDOuT—SESSION 4

Mga Payo sa Pag-inom ng Gamot para sa Mataas na Presyon ng Dugo

1. Tiyaking iinom ka ng gamot araw-araw tulad nang sinabi sa iyo ng iyong duktor, hindi lamang sa mga araw na hindi maganda ang iyong pakiramdam.
2. Sabihin sa duktor ang mga pangalan ng lahat ng iba pang mga gamot, panlunas sa bahay, herb, o pandagdag na iniinom mo. Dalhin ang lahat kapag mayroon kang appointment sa duktor.
3. Sabihin kaagad sa duktor kung may kakaiba kang nararamdaman sa iyong gamot o nagkakasakit ka. Hilingin sa duktor ang pagbabago o paglipat sa isa pang uri ng gamot.
4. Punang muli ang iyong reseta bago ka maubusan ng gamot.
5. Ipasuri ang iyong presyon ng dugo nang madalas upang makita kung umeepekto sa iyo ang gamot.
6. Huwag tumigil sa pag-inom ng iyong gamot kung maayos na ang iyong presyon ng dugo. Iyon ay nangangahulugang tumatalab ang gamot.

Mga katanungang dapat itanong sa duktor:

Kapag binigyan ka ng duktor ng gamot para sa mataas na presyon ng dugo, tanungin:

Ano ang pangalan ng (mga) gamot? ____________________________________

Dami ng iinuming gamot: ____________________________________________

Kailan dapat inumin ang (mga) gamot? _________________________________

Ano ang dapat kainin o inumin kasabay ng (mga) gamot: ___________________

Ligtas bang inumin ang ibang mga gamot nang sabay-sabay? ________________

_________________________________

Anong numero ang kaagad na matatawagan sa sandaling magkaroon ng problema:

_________________________________

HANDOuT—SESSION 4 137

Use Herbs and Spices Instead of Salt

Anise: Use in breads, snacks, soups, stews, vegetables, meats, and poultry. Annatto Seeds: Use in vegetables, meats, poultry, and rice. Basil: Use in soups, salads, vegetables, meats, and fish. Bay Leaf: Use in soups, stews, meats, poultry, seafood, and sauces. Chili Powder: Use in soups, salads, vegetables, and fish. Cilantro: Use in stews, meats, sauces, and rice. Cinnamon: Use in breads, snacks, salads, and vegetables. Clove: Use in breads, snacks, soups, salads, and vegetables. Dill Weed and Dill Seed: Use in soups, salads, vegetables, and fish. Garlic: Use in soups, stews, salads, vegetables, meats, poultry, seafood, and sauces. Ginger: Use in soups, salads, vegetables, meats, and seafood. Green Onion/Onion Powder: Use in soups, salads, meats, poultry, and seafood. Lemongrass: Use in soups, stews, meats, poultry, seafood, and sauces. Marjoram: Use in soups, salads, vegetables, meats, poultry, and seafood. Nutmeg: Use in breads, snacks, vegetables, and meats. Oregano: Use in soups, salads, vegetables, meats, and poultry. Parsley: Use in salads, vegetables, meats, poultry, and seafood. Rosemary: Use in salads, vegetables, meats, and seafood. Saffron: Use in breads, snacks, soups, stews, poultry, seafood, sauces, and rice. Sage: Use in soups, salads, vegetables, meats, and poultry. Tamarind: Use in soups, poultry, sauces, and rice. Thyme: Use in salads, vegetables, poultry, and fish. Vinegar: Use in soups, salads, vegetables, meats, and poultry.

Note: To start, use small amounts of these herbs and spices to see if you like them.

138 HANDOuT—SESSION 4

Fish Cardillo Recipe

This is a delicious low-cost recipe with low-sodium ingredients. Keep this recipe lower in fat by not adding meat fat (lard) or other fat.

1 pound (½ kg) red snapper

4 teaspoons ¼ cup 1 large 3 or 4

corn oil for saute flour onion, sliced medium-sized tomatoes, chopped

½ cup ½ cup A dash 15 stalks

egg whites, beaten water ground pepper green onions, chopped

Quick Tip

This recipe is lower in salt and sodium than most because it uses:

• Fresh tomatoes instead of canned tomatoes
• Ground pepper and corn oil with no salt added
• Fresh onion and green onions
• Regular fish, not smoked or canned fish

Source: Philippine Heart Center’s Healthy Heart Cookbook.

1. Clean fish very well. Remove scales and

gills, and wash thoroughly. Drain and set aside.

1. Slice the raw fish into six pieces.
2. Heat corn oil in frying pan.
3. Place the flour into a bowl or plastic bag.

Place the raw fish in the flour and cover the outside of each fish with flour.

1. Saute fish until golden brown. Set aside

on top of a paper towel.

1. Saute onion and tomatoes. Add ½ cup

of water.

1. Add the beaten egg whites and

fish. Cover and let it simmer for 5–10 minutes.

1. Season with ground pepper.
2. Sprinkle with chopped green onions.

Yield: 6 servings Serving size: Calories 170 Total Fat 4 g Saturated Fat 1 g Cholesterol 45 mg Sodium 115 mg Total Fiber 3 g Protein 20 g Carbohydrates 13 g Potassium 600 mg

SESSION

Lola’s Life Lessons: Session 4

One of my favorite proverbs is:

“Kung may itinanim, may aanihin.”

Translation: “If you plant, you will harvest.”

Rewards will not come to you unless you work for them. Your mind may want to live a better, healthy life, but you need to make changes to reach that goal. My food choices were not always the best.

Of course, the Philippines is always in my heart. When I long for home, I remember the smells and foods of my province. But my favorite dishes have a lot of sodium. So Mila and I had to look for healthy and tasty ways to prepare Filipino dishes with less sodium. Now, I notice when something is too salty, and I do not even use the saltshaker at the table anymore! It takes time to change; you have to start with small steps first.

Look at my son Jose. He is a good nurse, but he is not a good patient. Jose did not try to control his high blood pressure, and he had a stroke! Do not wait for an emergency before you act. Take care of yourself and your family. Plan for the future. Love your life and make changes now. Huli man daw at magaling, naihahabol din. It is never too late to offer anything that is good.

A Time To Reflect…

What things keep you from using less sodium in your foods or choosing foods with less sodium? What changes can you make in your life to continue on your journey to heart health?

(Use this space to write down your thoughts for this week’s session.)

140 HANDOuT—SESSION 4

Pledge for Life! Session 4

Take the pledge for life with Lola Idad. Try to do at least one of these activities by yourself and/or share with others.

Learn the stroke warning signs.

Share the stroke survival tips with your family and friends.

Know your family history of high blood pressure.

Use Nutrition Facts labels to help you choose low-sodium food products.

If available, choose low-sodium sauces and seasonings, or reduce the amount of sauces and seasonings that are high in sodium.

Choose canned soups that are lower in sodium or prepare homemade soup without adding salt.

Choose unsalted crackers for a snack instead of regular potato chips.

Reduce the amount of salt you add to foods.

Shop for fresh or frozen vegetables and fruits instead of canned vegetables and fruits.

Try the fish cardillo recipe and other heart healthy recipes.

Take the saltshaker off the table.

If you use traditional Asian medicine or home remedies, share this information with your doctor.

Other

HANDOuT—SESSION 4 141

s essi o n

Be Heart Smart: Keep Your Cholesterol in Check

Objectives

By the end of this session, group members will:

• Know what cholesterol is and how it affects the body.
• Know what healthy cholesterol levels are.
• Learn the steps they can take to lower their blood cholesterol levels.

Materials and Supplies

To conduct this session, you will need:

• “Healthy Heart, Healthy Family” manual and picture cards
• Blackboard and chalk or several large pieces of paper, markers, and tape
• How To Make an Artery Model (page 158)
• How To Explain the Artery Model (page 159)
• One empty paper towel roll
• Scissors
• Red construction paper and tape or red felt with sticky backing
• Red and yellow modeling clay

Session 5. Be Heart Smart: Keep Your Cholesterol in Check 143

• Six paper plates
• Set of measuring spoons
• Can of shortening or lard
• Bottle of vegetable oil*
• Choice of three of the following foods:*

• Coconut milk (canned)

• Cream cheese

• Snack cake (packaged cupcake)

• Sardines, canned in olive oil (3.5 ounces)

• Corned beef, canned

• Guava, fresh

• Soy milk, vanilla

• Coconut oil

Handouts

Give each group member these handouts during this session:

• (Optional) “List of Places Where Group Members Can Get Their Cholesterol Levels Checked†
• “Take Action To Control Your Cholesterol” (pages 177–178)
• “Fats and Oils To Choose” (pages 179–180)

_______________________

• You can use pictures of these foods.

† Prepare this list before the session. You may find information at your local health department,

hospital, or clinic.

144 Healthy Heart, Healthy Family: A Community Health Worker’s Manual for the Filipino Community

• “Read the Nutrition Facts Label To Choose Foods Lower in Saturated Fat, Trans Fat, and Cholesterol” (page 181)
• “Mila’s Breakfast Choices” (pages 182–184)
• (Optional) “Mila Teaches Rose About Heart Healthy Cooking Role Play” (page 185)
• “Lola’s Tips To Eat Less Saturated Fat and Cholesterol” (page 186)
• “Guess the Fat Activity” (page 187)
• “Cooking With Less Saturated Fat” (pages 188–189)
• “Reduced-Fat Adobong Manok (Marinated Chicken) Recipe” (page 190)
• “Lola’s Life Lessons: Session 5” (page 191)
• “Pledge for Life! Session 5” (page 192)

Session Outline

Introducing the Session

1. Welcome
2. Review of Last Week’s Session
3. About This Session

Conducting the Session

1. Facts About Blood Cholesterol
2. Cholesterol and Heart Disease
3. What Are Your Numbers?

A. What Are Triglycerides?

B. The Metabolic Syndrome and Your Health

Session 5. Be Heart Smart: Keep Your Cholesterol in Check 145

1. Healthy Arteries Activity
2. Facts About Saturated Fat, Trans Fat, and Cholesterol
3. Nutrition Facts Label Activity––Fats
4. (Optional) Mila Teaches Rose About Heart Healthy Cooking Role Play
5. Guess the Fat Activity
6. Cooking With Less Saturated Fat Activity
7. Reduced-Fat Adobong Manok (Marinated Chicken) Recipe Activity

Review of Today’s Key Points

Lola’s Life Lessons: A Time To Reflect

Pledge for Life!

Closing

Introducing the Session

1. Welcome

• Welcome group members to the session.

2. Review of Last Week’s Session

Last week, we talked about salt and sodium.

146 Healthy Heart, Healthy Family: A Community Health Worker’s Manual for the Filipino Community

• Ask the questions below, and give the correct answers if group members do not.

Q: Who remembers why you should try to limit the amount of salt and sodium in your diet?

A: You should cut back on salt and sodium to help prevent or lower high blood pressure.

Q: Does anyone remember some ways to reduce the amount of salt you eat?

A: To cut back on salt and sodium, you can:

• Check the Nutrition Facts label to choose foods lower in sodium, such as

light soy sauce (soy sauce with low sodium).

• Use fewer high-sodium sauces and ingredients, such as patis (fish sauce),

tuyo (salty dried fish), hibi (salty, dried shrimp), and bagoong (fermented fish paste).

• Use herbs and spices instead of salt to season foods.

• Eat more fruits, vegetables, and fat-free or low-fat milk products for snacks.

• Choose low-sodium or unsalted nuts, pretzels, crackers, and popcorn.

At the end of our last session, you made a pledge to choose foods lower in salt and sodium. Share with the group what you did. What problems did you have? How did you solve them?

Note: Allow 5 minutes for group members to respond.

3. About This Session

Today we are going to talk about high blood cholesterol as a risk factor for heart disease. You will learn what you can do to keep your blood cholesterol levels low. We will also do some group activities that show how much saturated fat is in some foods and how to cook with less saturated fat. We will also learn how to keep trans fat and cholesterol intake low.

Session 5. Be Heart Smart: Keep Your Cholesterol in Check 147

Last week, Lola’s family showed us that with courage and dedication, everyone can make changes so there will be less sodium in the foods they eat. Lola Idad encourages her family always to be thankful for and mindful of how they live their lives, including what they eat and how much. She often says, “Bilisan mo ang gawain. Hinay-hinay sa pagkain.” This means, “If it is work, do it fast; if it is food, eat it little by little.”

With Lola’s help, her family is now on the journey to heart health. In addition to watching their sodium intake, the de la Cruz family is lowering the amount of saturated fat they eat. Throughout this session, we will see examples of how the members of this family have made heart healthy changes to their eating habits.

Conducting the Session

1. Facts About Blood Cholesterol

If a person’s blood cholesterol level is too high, he or she is more likely to get heart disease. Here are some facts about blood cholesterol:

• About 107 million American adults have total blood cholesterol levels that

are above the desirable level. Of these, 38 million have high total blood cholesterol levels, meaning that they are at higher risk for clogged arteries and heart attack.

• Filipinas living in the United States have higher total cholesterol than

Caucasian women.

• In the United States, Asians and Native Hawaiians and other Pacific

Islanders are less likely than most ethnic groups to have their blood cholesterol checked.

148 Healthy Heart, Healthy Family: A Community Health Worker’s Manual for the Filipino Community

2. Cholesterol and Heart Disease

Note: This section explains what cholesterol is, why the body needs it, how much cholesterol the body needs, and where cholesterol comes from.

Cholesterol is a soft, waxy, fat-like substance found in the body. Your body uses cholesterol to produce hormones and some vitamins.

• Show picture card 5.1.

Cholesterol comes from two sources:

• Your liver makes all the cholesterol your body needs to keep you healthy.

When cholesterol is produced, it goes into the bloodstream. The cholesterol that travels in your bloodstream is called blood cholesterol.

• Cholesterol also comes from the food you eat. Foods that come from animals

have cholesterol. The cholesterol in the foods you eat is called dietary cholesterol. Other types of fat in foods that raise cholesterol are saturated fat and trans fat. Today we will learn how to lower your intake of these fats.

When too much cholesterol is in the blood, it increases the risk of a heart attack, stroke, and other health problems.

• Ask:

Do you know anyone who has high blood cholesterol?

Note: Allow about 2 minutes for group members to respond.

Several things affect your blood cholesterol level. You cannot change some of them, such as your age, whether you are a man or a woman, or your family history (having family members with high blood cholesterol). But you can change the types of food you eat, the amount of physical activity you do, and your weight.

Session 5. Be Heart Smart: Keep Your Cholesterol in Check 149

You can help prevent or lower high blood cholesterol by taking the following measures:

• Eating a heart healthy diet low in saturated fat, trans fat, and cholesterol.

• Being active every day.

• Maintaining a healthy weight.

• Show picture card 5.2.

• Cholesterol travels through the bloodstream in the form of packages called

“lipoproteins.” These packages are made of fat and protein.

• Low-density lipoproteins (or LDL) carry the cholesterol to your blood

vessels, clogging them like rust in a pipe. This is why LDL cholesterol is often called the “bad” cholesterol.

• Cholesterol also travels in the blood in high-density lipoproteins (or HDL).

HDL helps to remove cholesterol from your body, like removing rust from a pipe. This is why HDL cholesterol is often called the “good” cholesterol.

• Picture it this way:

• The LDL person in the car (bad blood cholesterol) throws fat and cholesterol into the street (blood vessels).
• The HDL person (good blood cholesterol) cleans up fat and cholesterol deposited by the LDL and puts it in the trash.

• Just remember, the “L” in LDL is for Lousy, and the Lower it is, the better.

The “H” in HDL is for Healthy, and the Higher it is, the better.

150 Healthy Heart, Healthy Family: A Community Health Worker’s Manual for the Filipino Community

3. What Are Your Numbers?

• Show picture card 5.3.
• Ask:

How do you find out if you have high blood cholesterol levels or too much fat in your blood?

Your blood cholesterol levels are measured with a blood test. The test can be done at a doctor’s office or at a cholesterol screening (for example, at a health fair).

• A lipid profile is the blood test done at the doctor’s office. It is a complete

test to measure the levels of each type of fat in the blood. It measures total cholesterol, LDL cholesterol, HDL cholesterol, and triglycerides. (We will talk about triglycerides later.) You have to fast for 12 hours before this test. This test is recommended for adults aged 20 or older.

• Screening sites may only test total cholesterol and sometimes HDL

cholesterol. If you are an adult aged 20 or older, you may need to follow up with the doctor for a complete lipid profile.

• Ask:

Have you ever had your blood cholesterol checked? If you have, do you remember your levels?

• Give group members the “Take Action To Control Your Cholesterol” handout (pages 177–178). Review the cholesterol levels.

Note: If participants should ask, explain that cholesterol is measured in milligrams per deciliter (mg/dL).

• Show picture card 5.4.

Session 5. Be Heart Smart: Keep Your Cholesterol in Check 151

Here are what the total cholesterol numbers (mg/dL) mean:

Less than 200 mg/dL Desirable—Keep up the good work.

200 –239 mg/dL Borderline high

• Depending on your other risk factors, you may be at a higher risk for heart disease.
• It is time to change your eating habits, increase your physical activity, and lose weight if overweight.

240 or more mg/dL High

• You are at a higher risk for clogged arteries and a heart attack.
• Ask your doctor what your risk is for heart disease.

Here is what your HDL and LDL cholesterol numbers (mg/dL) mean:

LDL (bad) cholesterol: Keep it low!

HDL (good) cholesterol: The higher the better!

Keep it 40 mg/dL or higher.

152 Healthy Heart, Healthy Family: A Community Health Worker’s Manual for the Filipino Community

More Information

Heart Disease Risk and Your LDL Level

The goal for the LDL (bad cholesterol) level is different for each person. It depends on the risk factors you have. The number of risk factors—such as high blood pressure, low HDL, family history of heart disease, age and gender, and smoking—affects your LDL goal. The higher your LDL level and the more risk factors you have, the greater your chances of developing heart disease or having a heart attack. Your doctor can help you set a goal for your LDL level.

A. What Are Triglycerides?

Have any of you heard of triglycerides?

Note: Allow 2 minutes for group members to answer.

Triglycerides are another type of fat in the blood. When you eat too many calories, drink alcohol, or smoke, your body makes more triglycerides. When your triglycerides are high, it puts you at increased risk for heart disease.

A healthy triglyceride level is less than 150 mg/dL.

People with high triglycerides often have low HDL cholesterol (good cholesterol). People with diabetes can also have high triglycerides and low HDL cholesterol.

Session 5. Be Heart Smart: Keep Your Cholesterol in Check 153

To have a healthy triglyceride level:

• Maintain a healthy weight or lose weight if you are overweight.

• Be physically active on all or most days of the week.

• Eat a heart healthy diet that is low in saturated fat, trans fat, and cholesterol.

• Limit candy, sweets, desserts, regular soda, juice, and other drinks high

in sugar.

• Avoid smoking cigarettes and drinking alcohol. Smoking raises triglycerides

and lowers HDL cholesterol. Excess alcohol also raises triglycerides.

More Information

Here is what your triglyceride number (mg/dL) means:

Less than 150 mg/dL Normal

150–199 mg/dL Borderline high You may be at an increased risk for heart disease. To lower your level, aim for a healthy weight, and be more physically active.

200–499 mg/dL High Weight control and physical activity are very important to lower your level. Watch out for other heart disease risk factors such as overweight and obesity, diabetes, low HDL, and high blood pressure.

500 or more mg/dL Very high See your doctor immediately! This level requires attention to prevent severe problems with your pancreas.

154 Healthy Heart, Healthy Family: A Community Health Worker’s Manual for the Filipino Community

• Ask:

Do you know what your triglyceride level is?

Note: Allow a few minutes for group members to respond.

• Encourage group members to make an appointment to have their cholesterol and triglycerides checked.
• Tell them to be sure to ask for their results and to write them down on their wallet cards.
• (Optional) Give group members a list of clinics and hospitals where they can get low-cost or free blood cholesterol testing.

B. The Metabolic Syndrome and Your Health

• Now, we are going to learn about the metabolic syndrome. This disorder is

made up of a group of five factors that affect heart health.

• Many people have this health problem and don’t know they have it.

As I name the five factors that make up the metabolic syndrome, hold up your fist. Raise one finger for each risk factor you have.

• Show picture card 5.5.

The five factors that make up the metabolic syndrome are:

• A low HDL (good) cholesterol level of below 50 for women and below

40 for men

• A triglyceride level of 150 mg/dL or more

Session 5. Be Heart Smart: Keep Your Cholesterol in Check 155

• A blood pressure of 130/80* mmHg or more (either number that is high

counts as a risk)

• A waist measurement greater than 35 inches (88 centimeters) for women and

greater than 40 inches (102 centimeters) for men

• Higher than normal fasting blood glucose (blood sugar) level of 100 or more

• Ask:

How many fingers (risk factors) do you have raised?

• If you have three or more of these factors, you have the metabolic syndrome.

• The metabolic syndrome raises your chances of developing heart disease,

diabetes, and stroke.

• People with the metabolic syndrome should lose weight and become

physically active.

If you think you have the metabolic syndrome, talk to your doctor.

4. Healthy Arteries Activity

Note: This section uses the picture cards and an artery model to show how cholesterol can collect on the walls of the arteries and slow down and block the flow of blood. Blocked arteries can cause a heart attack or stroke.

• Show picture card 5.6.

Blood flows freely to all cells of the body when arteries are normal and healthy.

_______________________

• The blood pressure level considered a factor for the metabolic syndrome is 130/80. This level is different from the level that defines high blood pressure, 140/90.

156 Healthy Heart, Healthy Family: A Community Health Worker’s Manual for the Filipino Community

When your LDL cholesterol is too high, cholesterol may become trapped in the walls of your arteries, causing them to harden. The opening of the arteries can become clogged and narrowed.

• Show the artery model.

Note: See page 159 for help explaining the artery model.

• Pass the artery model around so group members can look at it closely.
• Ask:

Have you ever seen someone fry food in lard and then dump the hot lard down the sink?

• Allow a moment for group members to respond. Then ask them why they should not do this.

It is because the lard will clog the pipes. Foods high in saturated and trans fat will clog your pipes (arteries). So, we want to treat our bodies just as well as we treat our pipes.

Session 5. Be Heart Smart: Keep Your Cholesterol in Check 157

How To Make an Artery Model

What you will need:

one empty paper towel roll scissors

red construction paper and tape or red felt with sticky backing

yellow modeling clay

What you need to do:

1. Cut construction paper or felt to fit around the outside of the roll.
2. Tape construction paper or stick felt around the outside of the roll.
3. Roll out thin pieces of yellow and red clay into doughnut-shaped figures.
4. Make one small, round ball of the red clay.

Healthy Heart, Healthy Family: A Community Health Worker’s Manual for the Filipino Community

How To Explain the Artery Model

1. Place the doughnut-shaped pieces of red clay on the outside edge of both ends of the roll.

Say:

This is a healthy artery. The blood can flow through the opening easily.

1. Add pieces of the yellow clay to the inside edge of the red clay on one end of the roll.

Say:

This is the beginning of a clogged artery. Cholesterol is starting to build up.

1. Continue to add pieces of yellow clay to this end of the roll. Add pieces until you almost fill in the opening completely.

Say:

The opening of the clogged artery is getting smaller. Blood cannot flow through easily.

1. Put a red ball in the small opening that is left at the end of the roll.

Say:

When the inside of an artery becomes narrowed, a blood clot may block an artery going to the heart. This may cause a heart attack. If the blood clot blocks an artery going to the brain, it may cause a stroke, or “brain attack.” Other problems caused by narrowed arteries are angina (chest pain) and poor blood circulation.

Session 5. Be Heart Smart: Keep Your Cholesterol in Check 159

5. Facts About Saturated Fat, Trans Fat, and Cholesterol

Today, we will talk about the different types of fat and how they affect heart health.

• There are two main types of fat—saturated fat and unsaturated fat. Most

foods contain some of both types. The saturated fat plus the unsaturated fat in food make up the total fat found in food.

• Saturated fat is found in foods that come from animals, such as high-fat

meats, cheese, milk, and butter.

• Another type of fat called trans fat also raises cholesterol. Trans fat is found

in a variety of baked goods (such as cookies, pies, and pastries), fried foods, stick margarine, and vegetable shortening. Choose light margarine (soft tub) instead of stick (hard) margarine, and look for trans-fat-free spreads in the grocery store.

• Eating too much saturated fat and trans fat will raise your blood cholesterol

level more than anything else you eat. This will raise your chances of developing heart disease.

It is important to limit the amount of saturated fat and trans fat you eat, but you need some dietary fat to be healthy. Fats are necessary because they are used by the body to:

• Store and provide energy.

• Help carry vitamins A, D, E, and K throughout the body.

• Ask:

What types of fat do you use to cook your food?

Note: Allow about 3 minutes for group members to answer. Write responses on the blackboard or on a large piece of paper taped to the wall.

160 Healthy Heart, Healthy Family: A Community Health Worker’s Manual for the Filipino Community

• Show group members a stick of butter (or a can of shortening or lard).

• Butter, shortening, and lard are examples of foods high in saturated fat.

• Saturated fat is usually solid at room temperature.

• Saturated fat is usually found in foods from animals.

• Show picture card 5.7.

Here are some foods that are high in saturated fat:

• Whole milk and products • Skin of chicken, turkey,

made from whole milk and pig (regular cheeses and

• Butter

cream cheese)

• Shortening • Ice cream and whipped

cream

• Lard • Fatty cuts of meat, such • Oils such as coconut, palm,

as chuck, regular ground and palm kernel beef, ribs, bacon, and

sausage; canned meat, such • Doughnuts, pastries, cakes,

as pork, corned beef, and and cookies vienna sausage

• Coconut milk

• Show picture card 5.8.

Here are foods that are lower in saturated fat:

• Lean meats such as loin, round, and extra lean ground beef

• Beans

• Tofu

Session 5. Be Heart Smart: Keep Your Cholesterol in Check 161

• Fish and seafood*

• Poultry without the skin

• Fat-free and low-fat milk, cheese, and yogurt

• Steamed rice

• Tub margarine

• Vegetable oil, such as canola, safflower, or sesame oil

• Fruits and vegetables

You want to limit the amount of saturated fat in your diet.

Even though vegetables and fruits are low in saturated fat, any plant food prepared with oil high in saturated fat (for example, eggplant or banana that is deep fried in coconut or palm oil) may raise your cholesterol level.

• Show group members a bottle of vegetable oil.

Unsaturated fats are usually liquid at room temperature. As mentioned before, a few oils (coconut, palm, and palm kernel) are high in saturated fat.

• (Optional) Say:

The types of unsaturated fats are polyunsaturated and monounsaturated.

_______________________

• Shrimp and crawfish have more cholesterol than most other types of fish and seafood, but they are lower in total fat and saturated fat than most meats and poultry.

162 Healthy Heart, Healthy Family: A Community Health Worker’s Manual for the Filipino Community

More Information

Polyunsaturated fat is found in:

• Vegetable oils
• Sesame oil
• Corn oil
• Sunflower oil
• Soybean oil
• Some types of fish

Monounsaturated fat is found in:

• Vegetable oils
• Canola oil
• Olive oil
• Peanut oil
• Avocados
• Nuts
• Give group members the “Fats and Oils To Choose” handout (pages 179–180).

The graph will quickly show you which products have the least saturated fat.

• Ask:

What four oils have the least saturated fat?

Canola oil, safflower oil, sesame oil, and sunflower oil have the least saturated fat.

Although polyunsaturated and monounsaturated fats are better for our health than saturated fat, we need to eat less of all types of fat. Fats are high in calories, and all fats have the same number of calories. Cutting back on calories helps us lose weight. We will talk about this in the next session.

• Show picture card 5.9.

Foods high in cholesterol can also raise your blood cholesterol and increase your risk of heart disease. Dietary cholesterol is found only in foods that come from animals. Foods that are highest in cholesterol are:

Session 5. Be Heart Smart: Keep Your Cholesterol in Check 163

• Egg yolks

• Organ meats, such as liver, kidneys, tripe, heart, and tongue

• Shrimp

• Show picture card 5.10.

Foods that come from plants do not contain cholesterol. Foods that do not contain cholesterol include:

• Fruits • Beans • Rice

• Vegetables • Tofu • Grains

• Cereals

Plant foods that are prepared with animal products (for example, tofu fried in lard) have cholesterol.

Plant foods are generally lower in saturated fat and don’t have cholesterol. They also contain a type of dietary fiber (soluble) that is beneficial for lowering cholesterol.

• Show picture card 5.11.

Soluble fiber is found in foods such as oats, fruits, barley, vegetables, and cooked dry beans and peas. So, this gives you one more reason to eat a variety of fruits and vegetables in addition to some whole-grain cereals such as oatmeal.

164 Healthy Heart, Healthy Family: A Community Health Worker’s Manual for the Filipino Community

Fruits and vegetables that are a good source of soluble fiber are citrus fruits (oranges and grapefruit), guava, mango, apples, papaya, peaches, pears, pineapple, bananas, brussels sprouts, broccoli, and carrots. For great sources of soluble fiber, try to include a variety of cooked dry beans, cabbage, green beans, and oatmeal. Avoid canned beans that contain high amounts of salt and sodium. Prepare beans at home, flavoring them with garlic and spices instead of salt.

6. Nutrition Facts Label Activity––Fats

• Give group members the “Read the Nutrition Facts Label To Choose Foods Lower in Saturated Fat, Trans Fat, and Cholesterol!” handout (page 181).
• Point out on the Nutrition Facts label where to find saturated fat, trans fat, and cholesterol.
• Show picture card 5.12.

For a healthier heart, use the Nutrition Facts labels to choose foods with a lower Percent Daily Value for saturated fat and cholesterol. If you have high cholesterol, you may need to aim for a lower percent for saturated fat and cholesterol. Try to keep trans fat as low as possible. A doctor or registered dietitian can help you with this.

• Show group members where the Percent Daily Value is found on the Nutrition Facts label for whole milk.

Look at the bottom of the handout. Look at the Percent Daily Value for whole milk and fat-free milk. Which is lower in saturated fat?

Session 5. Be Heart Smart: Keep Your Cholesterol in Check 165

Fat-free milk is lower in saturated fat. One cup of fat-free milk has none of the Percent Daily Value of saturated fat. One cup of whole milk has 25 percent, or one-fourth, of the Percent Daily Value of saturated fat.

Trans fat is now listed on all Nutrition Facts labels. It is listed on a line below saturated fat, as seen here. Compare labels to choose the food lowest in saturated fat, trans fat, and cholesterol.

• Give group members the “Mila’s Breakfast Choices” handout (pages 182–184).

Now look at “Mila’s Breakfast Choices.” We are going to use the Nutrition Facts label to practice choosing foods that are lower in fat. First, I am going to tell you about a problem for many busy people. Then, we will use Nutrition Facts labels to find some solutions.

166 Healthy Heart, Healthy Family: A Community Health Worker’s Manual for the Filipino Community

Mila’s Problem

Mila has little time in the morning to prepare breakfast. She often has bibingka (sweet rice cake) for breakfast, or leftovers, such as pork longanisa and fried rice. Look at the Nutrition Facts labels. Help Mila select some breakfast foods that are lower in saturated fat than her usual choices. It is also important to compare labels for trans fat and cholesterol amounts.

Note: The correct answer is underlined.

• Pork longanisa, sweet, or chicken siopao (steamed bun with chicken filling?

• Balut (duck egg, raw) or hardboiled egg?

• Doughnut or pan de sal (Filipino roll)?

• Fruit danish or banana?

• Butter or light margarine (soft tub)?

• Fried rice or white, steamed rice?

• Bibingka (sweet rice cake with coconut milk) or plain oatmeal?

• Strawberry-flavored milk or vanilla soy milk?

• Ask for a volunteer to describe:

• What he or she usually eats for breakfast

• Which foods are higher in fat

• What lower-fat foods can be chosen to replace them

Note: Write the answers on the blackboard or on a large piece of paper taped to the wall. Help the volunteer select some substitutes, if needed.

Session 5. Be Heart Smart: Keep Your Cholesterol in Check 167

7. (Optional) Mila Teaches Rose About Heart Healthy Cooking Role Play

Note: Ask for two volunteers to be the actors in the role play. Give these two group members the “Mila Teaches Rose About Heart Healthy Cooking Role Play” handout (page 185). As the trainer, you can read the introduction. After the activity is completed, allow 5 minutes for discussion by asking the following questions.

• Ask:

• What are some of the lessons we learned from this role play?

• Is there any part of the role play that you can use in your own life?

• Give group members the “Lola’s Tips To Eat Less Saturated Fat and Cholesterol” handout (page 186). Review the tips with the group.

8. Guess the Fat Activity

Before the session

1. Buy a can of shortening. Also buy paper plates and cups and three foods from this list (or use pictures of the foods):

cupcakes)

• 2 tablespoons coconut oil • Sardines, canned in olive oil

(3.5 ounces)

1. Write the name of each food you brought on a separate plate.
2. Look at the following chart. Find the amount of fat for each food you brought.

Note: You do not have to use all the food in the chart. Choose the foods that are eaten most often in your community.

168 Healthy Heart, Healthy Family: A Community Health Worker’s Manual for the Filipino Community

Teaspoons of Fat (Grams of Fat) Foods Note: 1 teaspoon looks like a single die.

1 ounce (about 2 tablespoons) About 2¼ teaspoons (9 grams)

coconut milk

1 ounce (about 2 tablespoons) About 2¼ teaspoons (9 g)

cream cheese

2 snack cakes (1 package cupcakes) About 4½ teaspoons (18 g)

1 can sardines (3.75 ounces), packed About 3¼ teaspoons (13 g)

in olive oil, drained

2 ounces (/ can) corned beef About 1¾ teaspoons (7 g)

1. From the can of shortening, spoon the amount of fat listed on the chart onto the plate labeled for that food.
2. Take the remaining plates, and place each food item (or a picture of the food) on the separate plates.
3. Put all the plates away until you are ready to do this activity.

Group Activity

We are going to play a guessing game that will help you learn about the total fat content of several foods. Learning which foods are higher in fat and how to replace them with foods that contain less fat will help you make healthier choices. Decreasing your total fat intake can help you reduce your saturated fat, trans fat, and calorie intake.

Session 5. Be Heart Smart: Keep Your Cholesterol in Check 169

• Give group members the “Guess the Fat Activity” handout (page 187).
• Show group members the plates of foods (or pictures of food) that you prepared ahead of time.

Guess how many teaspoons of fat are found in one serving of each of these foods. Write your guess on the “Guess the Fat Activity” handout.

Note: Ask group members to tell you the amount of fat they guessed for the first food item. After group members have shared their guesses, tell them the actual number of teaspoons of fat the food contains. Tell them to write this amount on their handout, too. Bring out the plate of fat you made ahead of time for that food to show them how much it is. Then do this for the other foods.

As you can see, it is easy to go over the limit for fat when we eat foods higher in fat, such as fried foods, some fast foods, hotdogs, coconut milk, chips, canned pork, corned beef, vienna sausages, bibingka (sweet rice cake), and ice cream. Eating foods lower in total fat will also help you reduce your saturated fat, trans fat, and cholesterol intake. To make it easier to cut back on fat, eat more foods that are lower in fat, such as fruits, vegetables, rice, whole-grain cereals and breads, beans, and fat-free or low-fat milk products.

• Ask:

How do you feel about the true amount of fat in the foods you guessed?

Note: Allow 3 to 5 minutes for group members to talk about their reactions.

There are lower-fat substitutes for some of the higher-fat foods that we eat often.

• Review the following list.

170 Healthy Heart, Healthy Family: A Community Health Worker’s Manual for the Filipino Community

Foods

Regular cheese

Evaporated whole milk

Lower-Fat Substitutions

Fat-free or low-fat cheese

Evaporated fat-free or low-fat milk or soy milk

Lard or coconut oil

Lumpiang shangai (fried lumpia)

Vienna sausage

Sardines, canned in olive oil

2 snack cakes

Canola oil, safflower oil, or sesame oil

Lumpiang sariwa (fresh lumpia)

Low-fat vienna sausage

Sardines, canned in tomato sauce

Fresh fruit, such as pineapple or fruit cocktail, in juice

12 ounces halo halo dessert (made with 12 ounces halo halo dessert (made with condensed milk) fat-free or low-fat milk)

You can also reduce the amount of fat you eat simply by eating higher-fat foods less often or in smaller amounts.

9. Cooking With Less Saturated Fat Activity

Note: This section provides information that will help group members cut back on the amount of saturated fat in their diets. This activity will help them understand that they can cut back on the fat without giving up their traditional foods.

• Ask:

Before we do this activity, can you tell me what you can do to cook with less saturated fat?

Note: Allow 3 minutes for group members to respond. Write their answers on the blackboard or on a large piece of paper taped to the wall.

Session 5. Be Heart Smart: Keep Your Cholesterol in Check 171

This next activity shows how to prepare foods with less saturated fat.

• Give group members the “Cooking With Less Saturated Fat” handout (pages 188–189). Review each of the dishes listed. Ask volunteers to read each recipe out loud.
• Ask:

What makes the recipes on the handout lower in saturated fat?

Note: Allow a few minutes for group members to respond.

• Add the following reasons if they are not mentioned:

• The pork is boiled instead of fried, and the fat is skimmed from the broth.

• The sauce is made with vegetables and herbs to provide additional flavoring.

• The potatoes are baked, not fried.

• The omelet recipe calls for just one egg, less oil, and low-fat milk.

Vegetables add flavor and fiber.

• The potato salad is made with low-fat or fat-free mayonnaise. Kalamansi

juice and diced vegetables are added for great flavor.

• The fruit shake is made with fat-free milk or yogurt instead of whole milk,

coconut milk, or ice cream.

10. Reduced-Fat Adobong Manok (Marinated Chicken) Recipe Activity

• Give group members the “Reduced-Fat Adobong Manok Marinated Chicken Recipe” handout (page 190).
• Ask:

How has saturated fat been reduced in this recipe?

172 Healthy Heart, Healthy Family: A Community Health Worker’s Manual for the Filipino Community

• Allow a moment for group members to respond. Add the following answers if they are not mentioned:

• The skin from the chicken has been removed.

• The chicken is boiled, not fried.

• The dish uses olive oil, which has less saturated fat than lard, palm oil, or

coconut oil.

• The dish is flavored with vegetables, light soy sauce, and herbs, instead

of salt.

• The dish is cooked and simmered slowly in moist heat instead of fried in fat.

Remember, foods that are lower in fat still contain calories. Check your portion sizes (including the side dishes, such as steamed rice). If you eat these foods in large quantities, you may gain weight.

Note: Ask if there are any questions. Encourage group members to try this recipe at home this week.

Review of Today’s Key Points

Let’s review what you have learned today.

What may cause your arteries to become clogged?

• Cholesterol buildup will clog the arteries.

What is considered a desirable total blood cholesterol level?

• Less than 200 mg/dL

Session 5. Be Heart Smart: Keep Your Cholesterol in Check 173

What steps can you take to keep your cholesterol level low?

• Eat foods lower in saturated fat, trans fat, and cholesterol.

• Maintain a healthy weight.

• Stay physically active.

• Eat a variety of whole grains, fruits, and vegetables.

Can you name some foods that are high in saturated fat?

• Lard, shortening, butter, fatty meats, poultry with skin, whole milk, coconut

milk, and coconut oil

What are some things you can do to make foods lower in fat?

• Trim the fat from meat before cooking.

• Take the skin off poultry, and throw it away.

• Bake, steam, broil, or grill food instead of frying it.

• Do not reuse pan drippings from fatty cuts of meat to cook other foods. • Cook the meat separately in a slow cooker (Crock-Pot®) so the fat can

be removed.

• Skim the fat off soups before serving.

Can you name some foods that are high in soluble fiber?

• Oats, cooked dry beans, and peas

• Fruits and vegetables such as citrus fruits (oranges and grapefruit), guava,

mango, apples, papaya, peaches, pineapple, bananas, brussels sprouts, broccoli, and carrots

174 Healthy Heart, Healthy Family: A Community Health Worker’s Manual for the Filipino Community

Lola’s Life Lessons: A Time To Reflect

This week, Lola and her family remind us that the steps to a healthy heart also require discipline. Discipline means taking control of your eating habits. With courage and discipline, you can limit foods high in saturated fat, trans fat, and cholesterol.

• Give each group member the “Lola’s Life Lessons: Session 5” handout (page 191). Ask a volunteer to read the handout.

Please take a few moments to reflect on Lola’s advice and how it applies to your life. At the bottom of the handout, there is a space called “A Time To Reflect.” Use this section to record your feelings about this week’s session. Please write down your thoughts. Remember, this is for you and no one else.

• Give each group member 2 to 3 minutes to write down some thoughts.

Pledge for Life!

You have learned a lot today about high blood cholesterol and how to eat less saturated fat, trans fat, and cholesterol. Now, let’s think about how you can apply what you have learned. Please think of one change you can make in your everyday life to keep your blood cholesterol in check.

Be specific about what you plan to do, how you plan to do it, and when you will start. Here are some examples:

• I will take the skin off the chicken, and I will throw the skin away.

• I will bake the fish instead of frying it in lard or grease.

Session 5. Be Heart Smart: Keep Your Cholesterol in Check 175

• Give each group member the “Pledge for Life! Session 5” handout (page 192).

Take the pledge for life with Lola Idad. Lola and her family have taken the pledge to practice heart healthy eating every day. Take a step toward eating less saturated fat, trans fat, and cholesterol. Pledge to do one thing on this list during the coming week.

Would anyone like to share his or her pledge with the group?

Note: Write down pledge ideas on the blackboard or on a large piece of paper taped to the wall.

Note: If someone says they will use less oil in cooking, ask them to give you an example.

We will discuss the results of your pledges next week. Remember to continue to work on your pledges to be physically active and eat less salt and sodium.

Closing

Thank you for coming today. What did you think of today’s session?

Note: Wait to see if group members respond.

I am looking forward to seeing you at the next session. The next session will be about maintaining a healthy weight.

Note for Educator: Think about today’s session. What worked and what didn’t work? Have you decided to lower the amount of saturated fat in your diet and to know your numbers based on what was covered in today’s session?

176 Healthy Heart, Healthy Family: A Community Health Worker’s Manual for the Filipino Community

Take Action To Control Your Cholesterol

Do you know your blood cholesterol numbers?

Get Checked Take Action

• A lipid profile is a blood test that measures your • Eating foods lower in saturated fat, trans

cholesterol and triglyceride levels. fat, and cholesterol; doing physical activity;

• Adults aged 20 and older should have a lipid profile and losing weight if overweight can help

test at the doctor’s office. you reduce your blood cholesterol level and prevent heart disease.

Here is what your blood cholesterol numbers mean:

Total cholesterol

Less than Desirable. Good for you! Keep up the good work! 200 mg/dL

200–239 mg/dL Borderline high. Depending on your other risk factors, you may be at a higher risk for heart disease. It is time to change your eating habits, increase your physical activity, and lose weight if overweight.

240 mg/dL or High. You are at a higher risk for clogged arteries and a heart attack. higher Ask your doctor what your risk is for heart disease.

Write Your Numbers Here

LDL (lousy, bad) cholesterol: Keep it low!

Total Blood Cholesterol: _____

Less than 100 mg/dL Optimal

LDL: _____________________

100–129 mg/dL Near optimal

HDL: _____________________

130–159 mg/dL Borderline high

Triglycerides: ______________

160 mg/dL or more High

HDL (healthy, good) cholesterol (mg/dL): The higher the better! Keep it 40 mg/dL or higher.

Triglycerides: Keep your triglycerides below 150 mg/dL.

Lola and Mila have learned that it is not difficult to get their families to eat foods lower in saturated fat, trans fat, and cholesterol.

How Lola and Mila switched their families from whole milk to fat-free milk

Lola and Mila slowly changed the milk their family drank from whole milk to fat-free milk. The first month, they served reduced-fat (2%) milk. During the next month, they served lowfat (1%) milk. Finally, they made the switch to fat-free milk. The change was so slow that they could not even taste the difference.

HANDOuT—SESSION 5 177

(continued)

Try some of these simple changes

When Shopping

Buy fat-free or low-fat (1%)

1.

milk and cheese.*

Buy vegetable oil spray. Spray

2.

it on baking pans and skillets instead of using a lot of fat to grease pans.

3. Use the Nutrition Facts label

to help you choose foods lower in saturated fat, trans fat, and cholesterol.

When Cooking

Trim the fat from meat, and

1.

remove the skin and fat from chicken and pork before cooking.

Cook ground meat, drain the fat,

2.

and rinse with hot tap water. This removes half the fat. Do not reuse the fat to cook other food.

3. Cool broths, soups, and stews,

and remove the layer of fat that rises to the top.

4. Use canola, safflower, or

sesame oil instead of saturated fats and oils, such as coconut oil, shortening, and lard.

When Eating

Use fat-free or low-fat salad

1.

dressing, mayonnaise, or cream cheese.

Use small amounts of tub

2.

margarine instead of butter.

Choose fruits and vegetables

3.

instead of high-fat foods such as chips or fries.

• Or lactose-free products

Lola Idad has learned that eating foods high in saturated fat can raise her blood cholesterol level. So she has modified her favorite bibingka (sweet rice cake) recipe by using low-fat milk for the coconut milk and low-fat tub margarine for the butter. Now the bibingka is lower in saturated fat, trans fat, and cholesterol, and it still tastes great.

Make your personal pledge to do what Lola has done! Look at these examples:

Breakfast

Use fat-free or low-fat milk in coffee or oatmeal.

.

Lunch

Use leftover roast beef to make a sandwich on whole-grain bread. Eat it with some raw carrots and an orange for dessert.

Dinner

Broil the chicken in olive oil, garlic, and onions. Remove and throw away the skin before cooking.

Snack

Eat fresh guava instead of ice cream.

Write the changes you will try to make this week:

The health of you and your family is priceless. Value it!

HANDOuT—SESSION 5

Fats and Oils To Choose

When you do use fats and oils, choose those with less saturated fat.

Lower in Saturated Fat—

Choose More Often

♥ Canola, corn, olive, sesame,

soybean, and sunflower oils

♥ Tub margarine

(especially light margarine)

Higher in Saturated Fat—

Choose Less Often

• Butter
• Solid shortening
• Lard
• Fatback
• Stick margarine

Read the Nutrition Facts Label To Choose Foods

Lower in Saturated Fat, Trans Fat, and Cholesterol!

Percent of Saturated Fat

Use this handy graph to help you choose products with the least amount of saturated fat. Look for the ♥.

Source: Adapted from Canola Council of Canada, “Canola Oil Dietary Fat” (www.canola-council. org/PDF/dietarychart.pdf#zoom=100), July 19, 2007.

HANDOuT—SESSION 5 179

Mga Dapat Piliing Mga Fats at Oils

Kapag gumagamit ka ng mga fats at oils, piliin ang mga may mas mababang saturated fat.

Mas mababa sa Saturated Fat—

Piliin nang Mas Madalas

♥ Canola, corn, olive, safflower,

Mas mataas sa Saturated Fat—

Piliin nang Mas Kaunti

• Mantekilya

soybean, sesame, at sunflower oils

• Solidong shortening

♥ Tub margarine (lalo na ang light

• Lard (taba ng hayop)

margarine)

• Stick margarine

Basahin ang Label ng Mga Katotohanan sa Nutrisyon Upang Makapili ng Mga Pagkaing Mas Mababa sa Saturated Fat, Trans Fat, at Kolesterol

♥ Porsyento ng Saturated Fat

♥ ♥ ♥ ♥

Gamitin ang madaling gamiting graph na ito upang matulungan kang makapili ng mga produktong may pinakakaunting saturated fat. Hanapin ang ♥.

Mapagkukunan: Alinsunod sa Canola Council ng Canada, “Canola Oil Dietary Fat” (www.canolacouncil.org/PDF/dietarychart.pdf#zoom=100, Hulyo 19, 2007.

180 HANDOuT—SESSION 5

Read the Nutrition Facts Label To Choose Foods Lower in Saturated Fat,

Nutrition Facts labels tell you what you need to know to choose foods that are lower in saturated fat,

The label tells you: Amount Per Serving The nutrient amounts are for one serving. So, if you have more or less than one serving, you need to add the corresponding nutrient amounts. For example, if you drink 2 cups of whole milk, you are drinking two servings. You would need to double the amount of calories, saturated fat, trans fat, and cholesterol.

Nutrients Here are the amounts of saturated fat, trans fat, and cholesterol in one serving. These amounts are given in grams (g) or milligrams (mg).

The Choice Is Yours— Compare!

Which one would you choose?

Except for calories and saturated fat, fat-free milk has all the nutrients of whole milk, including the calcium. That makes fatfree milk a better choice! Read Nutrition Facts labels, and choose products to keep your heart strong.

for a carton of whole milk.

Whole Milk

Serving Size and

Nutrition Facts

Serving Size 1 cup (8 fl. oz.) Number of Servings

Servings Per Container 8

The serving size is 8 fluid Amount Per Serving ounces (1 cup). There are eight servings in this carton.

Calories150 Calories from Fat 70

% Daily Value*

Percent Daily Value

Total Fat 8g 12%

Saturated Fat 5g 25% The Percent Daily Value Trans Fat 0g helps you compare products.

Cholesterol 35mg 12%

Choose products with

Sodium 125mg 5%

the lowest Percent Daily

Total Carbohydrate 12g 4%

Value for saturated fat and

Dietary Fiber 0g 0%

cholesterol. If you have

Sugars 11g

high blood cholesterol,

Protein 8g

you should eat even less Vitamin A 35% • Vitamin C 4% saturated fat, trans fat, and

Calcium 2% Iron 0% Vitamin D 25%

• • cholesterol. A doctor or registered dietitian can help you with this.

Calories 150 Calories from Fat 70

Whole Milk

% Daily Value*

One cup of whole milk

Total Fat 8g 12%

has 25 percent of the Daily

Saturated Fat 5g 25%

Trans Fat 0g Value of saturated fat. This

Cholesterol 35mg 12%

is one-fourth of the total

Sodium 125mg 5%

amount of saturated fat that you should have in 1 day.

Calories 90 Calories from Fat 0

This is too much!

% Daily Value*

Fat-Free Milk

Total Fat 0g 0%

Saturated Fat 0g 0% One cup of fat-free milk has

Trans Fat 0g

no saturated fat. You can

Cholesterol 0mg 0%

Sodium 125mg 5% learn a lot from a Nutrition Facts label.

are based on a 2,000-calorie diet. Your Daily Values may be higher or lower depending on your calorie needs. HANDO

Mila’s Breakfast Choices

Mila has 1 – Pork Longanisa, Sweet little time in the morning

Nutrition Facts

to prepare Serving Size 2 links (66g) breakfast. Servings Per Container 6 She often has

Amount Per Serving

bibingka (sweet

Calories210 Calories from Fat 150

rice cake) for breakfast, % Daily Value* or leftovers Total Fat 27g 41% such as pork Saturated Fat 6g 30% longanisa and Trans Fat 0g

Cholesterol 40mg 13%

fried rice.

Sodium 320mg 13% Lower Total Carbohydrate 6g 2%

Look at the saturated

Dietary Fiber 0g 0%

Nutrition Facts fat choice

Sugars 5g

labels. Help Protein 8g ______ Mila select

Vitamin A 4% Vitamin C 2%

some breakfast •

Calcium 0% • Iron 4%

foods that are lower in saturated fat than her usual 3 – Balut (Duck Egg, Raw) choices.

Nutrition Facts

Serving Size 1 egg (70g)

Which should

Servings Per Container 1

she choose?

Amount Per Serving

Write the number of your Calories130 Calories from Fat 90 choice for each

% Daily Value*

pair in the space

Total Fat 10g 15%

between the

Saturated Fat 3g 15%

labels.

Trans Fat 0g

Sugars 1g fat choice Protein 2g ______

Vitamin A 9% • Vitamin C 0% Calcium 4% • Iron 15%

2 – Chicken Siopao (Steamed Bun With Chicken filling)

Nutrition Facts

Serving Size 114g Servings Per Container 6

Amount Per Serving

Calories300 Calories from Fat 30

% Daily Value*

Total Fat 4g 6% Saturated Fat 1g 5% Trans Fat 0g

Sugars 11g Protein 12g

Vitamin A 100% • Vitamin C 0% Calcium 2% • Iron 6%

4 – Hard Boiled Egg

Nutrition Facts

Serving Size 1 egg Servings Per Container 1

Amount Per Serving

Calories 80 Calories from Fat 50

% Daily Value*

Total Fat 5g 8% Saturated Fat 2g 10% Trans Fat 0g

Sugars 0g Protein 6g

Vitamin A 6% • Vitamin C 0% Calcium 2% • Iron 0%

are based on a 2,000-calorie diet. Your Daily Values may be higher or lower depending on your calorie needs.

182 HANDOuT—SESSION

Mila’s Breakfast Choices

5 – Fruit Danish

Nutrition Facts

Serving Size 1/8 (57g) Servings Per Container 8

Amount Per Serving

Calories160 Calories from Fat 72

% Daily Value*

Total Fat 8g 12% Saturated Fat 1.5g 8% Trans Fat 1g

Sugars 13g Protein 2g

Vitamin A 0% • Vitamin C 4% Calcium 10% • Iron 2%

7 – Butter

Nutrition Facts

Serving Size 1Tbsp (14g) Servings Per Container 32

Amount Per Serving

Calories100 Calories from Fat 100

% Daily Value*

Total Fat 11g 17% Saturated Fat 8g 40% Trans Fat 0g

Sugars 0g Protein 0g

Vitamin A 8% • Vitamin C 0% Calcium 0% • Iron 0%

6 – Banana

Nutrition Facts

Serving Size 1 medium (126g) Servings Per Container 1

Amount Per Serving

Calories 110 Calories from Fat 0

% Daily Value*

Total Fat 0g 0% Saturated Fat 0g 0% Trans Fat 0g Cholesterol 0mg 0% Sodium 0mg 0% Lower Total Carbohydrate 29g 10% saturated Dietary Fiber 1g 4% fat choice Sugars 21g ______ Protein 1g

Vitamin A 0% • Vitamin C 0% Calcium 0% • Iron 0%

8 – Light Margarine (Soft Tub)

Nutrition Facts

Serving Size 1Tbsp (14g) Servings Per Container 80

Amount Per Serving

Calories 50 Calories from Fat 50

% Daily Value*

Total Fat 6g 9% Saturated Fat 1.5g 8% Trans Fat 0g Cholesterol 0mg 0% Sodium 55mg 2% Lower Total Carbohydrate 0g 0% saturated Dietary Fiber 0g 0% fat choice Sugars 0g ______ Protein 0g

Vitamin A 10% • Vitamin C 0% Calcium 0% • Iron 0%

are based on a 2,000-calorie diet. Your Daily Values may be higher or lower depending on your calorie needs.

u

Mila’s Breakfast Choices

9 – Fried Rice

Nutrition Facts

Serving Size 1 cup (185g) Servings Per Container 4

Amount Per Serving

Calories450 Calories from Fat 80

% Daily Value*

Total Fat 9g 14% Saturated Fat 5g 25% Trans Fat 0g

Sugars 1g Protein 12g

Vitamin A 6% • Vitamin C 1% Calcium 2% • Iron 28%

11 – Strawberry-flavored Milk

Nutrition Facts

Serving Size 8 fl oz Servings Per Container 4

Amount Per Serving

Calories230 Calories from Fat 80

% Daily Value*

Total Fat 9g 14% Saturated Fat 5g 25% Trans Fat 0g

Sugars 30g Protein 7g

Vitamin A 6% • Vitamin C 0% Calcium 25% • Iron 0%

10 – White Rice, Steamed

Nutrition Facts

Serving Size 1 cup (158g) Servings Per Container 4

Amount Per Serving

Calories210 Calories from Fat 5

% Daily Value*

Total Fat 0g 0% Saturated Fat 0g 0% Trans Fat 0g Cholesterol 0mg 0% Sodium 2mg 0% Lower Total Carbohydrate 45g 15% saturated Dietary Fiber 1g 4% fat choice Sugars 1g ______ Protein 6g

Vitamin A 0% • Vitamin C 0% Calcium 2% • Iron 11%

12 – Soy Milk, Vanilla

Nutrition Facts

Serving Size 8 fl oz Servings Per Container 4

Amount Per Serving

Calories 90 Calories from Fat 30

% Daily Value*

Total Fat 4g 6% Saturated Fat 1g 5% Trans Fat 0g Cholesterol 0mg 0% Sodium 160mg 7% Lower Total Carbohydrate 11g 4% saturated Dietary Fiber 2g 8% fat choice Sugars 6g ______ Protein 6g

Vitamin A 10% • Vitamin C 0% Calcium 30% • Iron 8%

are based on a 2,000-calorie diet. Your Daily Values may be higher or lower depending on your calorie needs.

HANDO

Mila Teaches Rose About Heart Healthy Cooking Role Play

Rose and her family moved to the United States a few years ago. Rose often looks to her sister-in-law, Mila, for advice.

Rose: Ate,* that fish cardillo dish you made last week was so good! Since the stroke, Jose has been trying to be really careful with what he eats, but it has been hard. He does not believe that something healthy can taste good! Can you teach me how to make something that tastes good and is healthy?

Mila: Sure! Mama and I tried many different recipes. Trying to eat heart healthy was a difficult change for us all. And Jose is hardheaded like my Cesar. They both think that Filipino dishes can only be made the way they make them back home. But now, Cesar and the kids hardly notice the difference.

Rose: So, what kind of changes did you make?

Mila: Well, it was very hard to stop using the fat left in the pan when we cook meat. Back home, everyone saves and reuses that fat for everything. It is a good way to save money and can make dishes more flavorful. But now I drain off the fat when I cook meat, and throw it away, because it is high in saturated fat. If a dish needs fat, I just use a little bit of canola oil and flavor it with herbs and spices. Try it!

Rose: Oh, I think they will notice the difference!

Mila: You will be surprised. Just make the changes little by little. Your family will like the dishes as much as ever.

Rose: So, Ate, when is my first cooking lesson?

Mila: Whenever you want, Rose! You know, I am always here for you.

• Ate means “elder sister” in Tagalog. It is common to address an older woman for whom you have a lot of respect as “Ate,” whether she is blood related or not.

HANDOuT—SESSION 5 185

Lola’s Tips To Eat Less Saturated Fat and Cholesterol

Healthy Cooking Tips

• Bake, steam, broil, or grill food instead of frying.
• Remove the skin from chicken and other poultry before cooking.
• Cool broth, soups, and stews, and skim off fat before serving.
• Use oils low in saturated fat, such as canola, safflower, and sesame oil.
• Trim visible fat from pork and other fatty meats before cooking.
• Use the slow cooker (Crock-Pot®) to cook meats and stews, and skim the fat off

the surface before serving.

• Flavor the food with vegetables, herbs, and spices—not with fat!

Choose MORE Often

• Chicken—breast, drumstick (skin

removed before cooking)

• Pork—ears, neck bone, feet,

ham hocks

• Beef—tripe
• Fish and seafood*

Choose LESS Often

• Chicken—wing, thigh (skin on while

cooking)

• Pork—hog maws, luncheon meat,

vienna sausage, bacon, ribs

• Fatty cuts of meat
• Beef oxtail

• Lean cuts of meat (such as round, • Organ meats (such as liver, kidney,

sirloin, and loin)

• Egg whites
• Vegetable oil (such as canola,

brains, and tongue)

• Egg yolks
• Lard, butter, shortening

safflower, or sesame oil)

• Shrimp and crawfish have more cholesterol than most other types of fish and seafood. But they are lower in total fat and saturated fat than most meats and poultry.

Source: Adapted from Be Heart Smart! Eat Foods Lower in Saturated Fat and Cholesterol, NHLBI, and http://www.americanheart.org/presenter.jhtml?identifier=516.

186 HANDOuT—SESSION 5

Guess the Fat Activity

Try to guess how much fat (in teaspoons) is found in each food. Write your answers on the “My Guess” line.

Teaspoons of Fat

Food My Guess True Amount

2 tablespoons coconut milk

1 tablespoon cream cheese

2 snack cakes (1 package cupcakes)

Sardines in olive oil, canned (1 package = about /3 cup)

2 ounces corned beef, canned (2 ounces = /6 canned corned beef)

1 guava, fresh

2 tablespoons coconut oil

8 ounces soy milk, vanilla

HANDOuT—SESSION 5 187

Cooking With Less Saturated Fat

Pork Puchero

1. Simmer 2 pounds cubed pork (0.9 kg) in a large pot filled with boiling water. Reduce heat, and simmer on low heat for at least 2 hours so the meat can achieve the right tenderness. Remove the meat from the pot. Skim fat from the water (broth). Add ¼ pound (0.1 kg) green beans, 2 potatoes (cubed), and 1 head of cabbage (sliced) to the broth.
2. In a medium saucepan, saute 1 chopped celery stalk, 1 chopped green pepper, 4 chopped green onions, and 2 cloves crushed garlic in 1 tablespoon vegetable oil.
3. Add ½ cup low-sodium tomato sauce. Simmer for a few minutes so the flavors can mix. Add some pork broth from the previous pot and 1 cup chickpeas (garbanzo beans).
4. Serve steamed white or brown rice in deep dishes. Place a scoop of the pork and vegetables over the rice and pour the tomato sauce on top.

Adapted from http://www.filipinorecipe.com/meat_and_fish_dishes/beef_puchero.htm.

Oven-Baked Potatoes

1. Cut potatoes in the shape of thick french fries.
2. Leave peel on. Arrange on a baking sheet that has been lightly sprayed with nonstick cooking spray.
3. Bake at 350 °F for 1 hour.

Eggplant Omelet

1. Saute ½ cup chopped eggplant, ½ cup chopped onion, and 1 bay leaf in 2 teaspoons vegetable oil. Continue cooking until the vegetables are tender, and remove them from the heat. Remove and discard the bay leaf.
2. Whip 1 egg with ¼ cup low-fat milk.
3. Grease an 8-inch skillet with 1 teaspoon vegetable oil. Pour whipped egg and milk into the greased and heated skillet, and cook so the egg batter resembles a pancake or omelet. Flip the omelet.
4. Pour the eggplant and onion on half of the omelet and fold over.
5. Slide the omelet onto a plate. Open the omelet, and season with black pepper. Refold before eating.

188 HANDOuT—SESSION 5

Cooking With Less Saturated Fat (continued)

Kamote (Sweet Potato) Salad

1. Dice boiled sweet potatoes to yield 2 cups.
2. To make the dressing, combine 1 tablespoon kalamansi juice, /3 cup low-fat mayonnaise, 1 tablespoon diced onion, 2 tablespoons diced celery, 1 tablespoon diced reduced-sodium pickle, 2 tablespoons diced red pepper, and ¼ teaspoon salt.
3. Pour dressing over the 2 cups of diced sweet potatoes and mix.
4. Can be served warm or chilled.

Source: http://www.filipinovegetarianrecipe.com/salads/sweet_potato_salad.htm.

Note: The very sour kalamansi looks like a small, round lime and tastes like a cross between a lemon and a mandarin orange. It is very popular in the Philippines. You may substitute 3 parts lemon juice to 1 part mandarin orange juice, mixed together, for the kalamansi.

Fruit Shake

1. Cut your favorite fruit into chunks.
2. Place in a blender, along with fat-free milk or plain, fat-free yogurt, vanilla extract, and ice.
3. Blend until smooth.

HANDOuT—SESSION 5 189

Adobong Manok (Marinated Chicken) Recipe

This is a delicious low-cost recipe with low-sodium ingredients. Keep this recipe lower in fat by not adding meat fat (lard) or other fat.

1 pound (½ kg) chicken breasts, no skin

1 teaspoon 2 tablespoons ¼ cup 1 teaspoon 2

olive oil light soy sauce vinegar paprika cloves fresh garlic, crushed 2 medium onions, chopped

2 tablespoons 1 1

black pepper, ground bay leaf, broken in half medium red tomato (optional)

Quick Facts

This recipe is lower in saturated fat and cholesterol because:

• The dish is made using chicken without the skin, and any extra fat is removed.
• Only 1 teaspoon of unsaturated fat (olive oil) is added.
• The dish is flavored with vegetables and herbs and is boiled and broiled slowly in moist heat instead of fat.

Source: Filipino-American Nutrition and Fitness Teachers Guide, Kalusugan Community Services, San Diego, CA.

1. Combine olive oil, garlic, and onion in

a frying pan. Add chicken, and saute together until chicken has browned.

1. Add light soy sauce, vinegar, paprika,

black pepper, and bay leaves, and stir.

1. Bring to a boil. Simmer for 45–60

minutes or until chicken is done.

1. Remove the chicken, and save the liquid

in the pot. Arrange the chicken on a broiler pan. Broil until the chicken has nicely browned. Remove from the broiler, and place it in a serving bowl.

1. Continue to boil the sauce in the

uncovered pan until volume is reduced to about half and the sauce is thick.

1. Pour the thickened sauce over broiled

adobo (chicken), and garnish with red tomatoes. Garnish adobong with red tomatoes, if desired.

Yield: Serving size 4 servings ½ cup: Calories 190 kcal Total Fat 5 g Saturated Fat 1 g Cholesterol 70 mg Sodium 330 mg Total Fiber 2 g Protein 26 g Carbohydrates 10 g Potassium 370 mg

Lola’s Life Lessons: Session 5

One of my favorite proverbs is:

“Bilisan mo ang gawain. Hinay-hinay sa pagkain.”

Translation: “If it is work, do it fast. If it is food, eat it little by little.”

To have food on the table is a blessing. Growing up in the province, my family and I never took this for granted. Food was always appreciated and respected. Today, there are too many food choices. When I first came here, I was overwhelmed, because seafood and cuts of meat were fresh and relatively cheap. So many snack foods and fast foods are available, too. These are expensive in the Philippines, but here, we can have them all the time.

How lucky I felt! I ate more foods that were high in fat and cholesterol. Mila and I were always making steak and fried bangus (milkfish). You feel wealthy living here and being able to afford these foods. It was only after Dr. Cabaya told me I had high blood pressure that I began to watch what I ate. It is hard, especially when you are trying to be a role model for the family.

But you need to have discipline. Kung ang isa ay hindi makapag disisyon, saya ay walang

kinabukasan. (“One who cannot decide will have no future.”) Think about what you eat,

how much you eat, and be consistent. Make changes for life, not just for the day, and not just for yourself, but for your family, too.

A Time To Reflect…

What things keep you from eating foods lower in saturated fat, trans fat, and cholesterol? What changes can you make in your life to continue on your journey to heart health?

(Use this space to write down your thoughts for this week’s session.)

HANDOuT—SESSION 5 191

Pledge for Life! Session 5

Take the pledge for life with Lola Idad. Try to do at least one of these activities by yourself or with others.

Choose low-fat and fat-free food products more often.

Bake, steam, broil, or grill food instead of frying it.

Cut off the fat from the meat before cooking it.

Use less coconut milk and condensed milk to prepare food and drinks.

Skim the fat off soups and stews before serving.

Throw away—and do not reuse—the fat that is drained from fatty cuts of meat.

Choose unsaturated fat and oils to prepare foods.

Take the skin off chicken or lechon, and do not eat it.

Include a variety of fruits, vegetables, and oatmeal as sources of soluble fiber.

Exchange low-fat recipes with your friends and family.

Other

192 HANDOuT—SESSION 5

s essi o n

Keep the Beat: Aim for a Healthy Weight

Objectives

By the end of this session, group members will learn that:

• Being overweight is a risk factor for high blood cholesterol, high blood pressure, diabetes, heart disease, and stroke.
• Healthy weights are given in ranges.
• Losing weight or keeping a healthy weight means making lifelong changes.
• Fad diets usually do not work over the long term and can be harmful.

Materials and Supplies

To conduct this session, you will need:

• “Healthy Heart, Healthy Family” manual and picture cards
• Blackboard and chalk or several large pieces of paper, a marker, and tape
• Two bathroom scales
• A tape measure you can attach to the wall (to measure height)
• A cloth tape measure (to measure the waist)

Session 6. Keep the Beat: Aim for a Healthy Weight 193

• (Optional) Curling ribbon (to measure the waist)*
• A Nutrition Facts label (from a can or package)
• 10 serving dishes or firm paper or plastic plates
• Four measuring cups
• Five spoons
• One knife
• Food

• A 42-ounce box of dry oatmeal

• A 15-ounce can of fruit or vegetables

• A block of cheddar cheese (about ½ pound)

• 3 cups of steamed rice

• A 12- or 15-ounce can of corned beef hash

Handouts

Give group members these handouts during this session:

• “Body Mass Index (BMI) Chart” (pages 216–217)
• “Do You Need To Lose Weight?” (page 218)
• “Commit to Losing Weight: Make Long-Term Changes!” (page 219)
• “Lola’s Habits and Her Weight” (pages 220–221)
• “Lola’s Tips To Help You Control Your Weight” (page 222)
• (Optional) “A Visit From Back Home: Embracing a Balanced Lifestyle Role Play” (page 223)

_________

• If you choose to use ribbon instead of measuring tape, cut one ribbon at 35 inches for women and one ribbon at 40 inches for men.

194 Healthy Heart, Healthy Family: A Community Health Worker’s Manual for the Filipino Community

• “Serving Sizes” (page 224)
• “Read the Nutrition Facts Label for Calories!” (page 225)
• “Lola’s Snack Choices” (pages 226–228)
• “Lumpiang Sariwa (Fresh Lumpia) Recipe” (pages 229–230)
• “Lola’s Life Lessons: Session 6” (page 231)
• “Pledge for Life! Session 6” (page 232)

Session Outline

Introducing the Session

1. Welcome
2. Review of Last Week’s Session
3. About This Session

Conducting the Session

1. Facts About Overweight and Obesity
2. Your Weight and Your Health
3. What Is a Healthy Weight? Activity
4. The Healthy Way To Lose Weight
5. Beat Weight-Loss Barriers
6. (Optional) A Visit From Back Home: Embracing a Balanced Lifestyle Role Play
7. Serving Size Activity
8. Nutrition Facts Label Activity––Calories
9. Lumpiang Sariwa (Fresh Lumpia) Recipe

Session 6. Keep the Beat: Aim for a Healthy Weight 195

Review of Today’s Key Points

Lola’s Life Lessons: A Time To Reflect

Pledge for Life!

Closing

Introducing the Session

1. Welcome

• Welcome group members to the session.

2. Review of Last Week’s Session

Last week, we talked about why it is important to cut back on saturated fat, trans fat, and cholesterol. Can you tell me three things you can do to make food lower in fat?

Note: Add these possible answers if not mentioned by group members:

• Trim the fat from meat before cooking.
• Remove the skin from chicken and the fat from pork and fatty meats before cooking. Throw away the skin and fat.
• Bake, steam, broil, or grill food instead of frying it.
• Ask:

At the end of the last session, you made a pledge to eat less saturated fat, trans fat, and cholesterol. What went well? Did you have any problems?

196 Healthy Heart, Healthy Family: A Community Health Worker’s Manual for the Filipino Community

Note: Allow 5 minutes for group members to respond.

3. About This Session

Today, we will discuss why keeping a healthy weight is important to heart health.

When the session ends, you will know that:

• Being overweight increases your chances for high blood cholesterol, high

blood pressure, diabetes, heart disease, and stroke.

• To lose weight:

• Cut down on the calories you eat.
• Eat smaller portions.
• Be physically active.

• Fad diets usually do not work over the long term and can be harmful to you.

You will also find out if you need to lose weight by learning your body mass index (BMI) and your waist measure.

The de la Cruz family is trying to stay on track with healthy eating and being physically active. They have faced many challenges along the way, but Lola Idad always reminds them that “Ang buhay ay parang gulong minsang nasa ibabaw, minsang nasa ilalim.” This means, “Life is like a wheel; sometimes you are on top, sometimes you are on the bottom.” Lola believes that it is important to lead a balanced lifestyle if we want to meet our goals. In this session, Lola will share her story of working toward and maintaining a healthy weight.

Session 6. Keep the Beat: Aim for a Healthy Weight 197

Conducting the Session

1. Facts About Overweight and Obesity

• Overweight and obesity increase the risk of heart disease and stroke. Losing 5 to 15 percent of body weight can make a difference.
• Among Asian adults (aged 18 and older) in the United States, about 25 percent are overweight. About 6 percent of those adults are obese.
• About 34 percent of the Filipino residents living in Hawaii are overweight, and 13 percent are obese.
• In the Philippines, about 24 percent of the adults (aged 20 years or older) are overweight or obese.

2. Your Weight and Your Health

Being overweight or obese increases your risk of heart disease and stroke. It also can contribute to the development of high blood cholesterol, high blood pressure, and diabetes. These can also cause heart disease.

Being overweight can increase the risk of developing some types of cancer. It can also make other health problems worse, such as arthritis and sleep disorders.

Losing a small amount of weight can improve many health problems that come from being overweight.

198 Healthy Heart, Healthy Family: A Community Health Worker’s Manual for the Filipino Community

3. What Is a Healthy Weight? Activity

Note: Before beginning this activity, place the scales where group members can weigh themselves in private. Write the following information on the blackboard or on a large piece of paper taped to the wall.

Cesar weighs 175 pounds (79.5 kg). He is 5 feet, 6 inches (1.68 meters) tall.

Mila weighs 125 pounds (56.7 kg). She is 5 feet (1.52 meters) tall.

• Give group members the “Body Mass Index (BMI) Chart” handout (pages 216–217).

We are going to do an activity to find out if you have a healthy weight or if you should lose weight.

• Show picture card 6.1.

First, we’re going to work together to find out if Cesar and Mila have healthy weights. We will use the Body Mass Index chart. The BMI chart lets us measure the weight of a person in relation to his or her height. The chart will help us find the BMI.

Cesar weighs 175 pounds (79.5 kg), and he is 5 feet, 6 inches (1.68 meters) tall. His wife, Mila, weighs 125 pounds (56.7 kg), and she is 5 feet (1.5 meters) tall.

Let’s use the BMI chart on the handout that I gave you to find out if Cesar and Mila have healthy weights.

Session 6. Keep the Beat: Aim for a Healthy Weight 199

Look for Cesar’s weight on the side of the chart, and circle it. Put your finger on the circled number, and lower your finger until you find the line that corresponds to Cesar’s height. The shade of the square will tell you if his weight is healthy or if he is overweight or obese.

Note: Allow 2 or 3 minutes for group members to look for the answer on the chart.

Now we will find Mila’s BMI, following the same steps.

Note: Allow 2 or 3 minutes for group members to look for the answer on the chart.

Cesar’s BMI is 28, so he is overweight. Mila’s BMI is 24, so she is at a healthy weight.

Now we are going to find out if you have a healthy weight. If you do not know how much you weigh, use the scale to weigh yourself. If you do not know your height, use the wall measure.

Note: Allow 15 minutes for group members to use the scales and wall measure.

• Give group members the “Do You Need To Lose Weight?” handout (page 218).

Now we’re going to take three simple steps to learn if we need to lose weight, and then we’re going to find out what actions we should take.

The first step is to find out our BMIs, using the chart on the handout that I gave you. We will follow the same process that we used with Cesar and Mila.

200 Healthy Heart, Healthy Family: A Community Health Worker’s Manual for the Filipino Community

Find your weight at the top of the chart, and circle it. Put your finger on the circled number, and lower your finger until you find the line that corresponds to your height. The shade of the square will show you if your weight level is healthy, overweight, or obese. You do not have to share your BMI number with the group. Just check off your weight level on the handout.

Please raise your hand if you are having trouble, and I will help you.

The second step is to measure your waist.

• Show picture card 6.2.
• Ask group members to measure their waists using the measuring tape.

Waist Measure

(Optional) Note: Some people may be sensitive about measuring their waists with a tape measure. To make this activity friendlier, you can use curling ribbon. Cut one ribbon at 35 inches (88 centimeters) for women and one ribbon at 40 inches (102 centimeters) for men, and give the ribbon to group members. Tell them how long the ribbon measures. If the ribbon does not go all the way around the group members’ waists, their waist measures are high.

Write down your waist measure, and check off the level of your waist measure: healthy or high. A waist measure greater than 35 inches (88 cm) for women and greater than 40 inches (102 cm) for men is high. A high waist measure increases your risk for heart disease.

Session 6. Keep the Beat: Aim for a Healthy Weight 201

In the third step, we will find out if you need to lose weight. Look at your BMI and waist measure.

If both are healthy, then you are at a healthy weight and do not need to lose weight. Good for you! Try not to gain weight.

• Copy the text in the “Risk Factors” box onto the blackboard or a large piece of paper taped to the wall.

Risk Factors

• High blood pressure
• High LDL cholesterol (bad

cholesterol)

• Low HDL cholesterol

(good cholesterol)

• High blood glucose
• Family history of heart

disease

• Not being physically active
• Smoking

• High triglycerides

Let’s review these risk factors.

• Ask:

How many of these risk factors do you have?

Note: Allow a moment for group members to think about their answers to this question.

If your BMI is in the overweight range, and you have two or more of the risk factors we just listed, you should lose weight. It is important not to gain more weight. You should also lose weight if you are overweight with a high waist measure.

202 Healthy Heart, Healthy Family: A Community Health Worker’s Manual for the Filipino Community

If your BMI is in the obese range, you also need to lose weight. It is important to lose weight slowly—about 1 to 2 pounds (0.45 to 0.91 kg) a week. Ask your doctor or a registered dietitian for help.

Note: Ask group members to look at the handout to see what actions they should take for their weight levels.

Level

Healthy Weight

Overweight

Action

• Good for you! Try not to gain any weight.
• It is important not to gain more weight.

• You need to lose weight if you are overweight

and:

• Have two or more risk factors, or
• Have a high waist measurement.

• Ask your doctor or a registered dietitian for help.

Obese • You need to lose weight. Lose weight slowly—

about 1 to 2 pounds (0.45 to 0.91 kg) a week.

• Ask your doctor or a registered dietitian for help.

4. The Healthy Way To Lose Weight

Let’s talk about the healthy way to lose weight.

The measure of energy that the body gets from food is called a calorie. People gain weight when they eat more calories than their body uses for energy.

Session 6. Keep the Beat: Aim for a Healthy Weight 203

If you need to lose weight, you must choose foods with fewer calories or become more physically active. It is best to do both.

To lose weight, you must burn more calories than you eat.

Pregnant women should not try to lose weight.

• Give group members the “Commit to Losing Weight: Make Long- Term Changes!” handout (page 219) and “Lola’s Habits and Her Weight” handout (pages 220–221).

Please review the “Commit to Losing Weight: Make Long-Term Changes” handout to find out how Lola found success managing her weight.

The “Lola’s Heart Healthy Habits and Her Weight” handout is about how adding small amounts of daily activity can lead to weight loss over time.

• Ask for volunteers to read each scene aloud.
• Show picture card 6.3.

Like Lola in the third scene, you can lose weight in a healthy way: Eat smaller portions, eat a variety of foods lower in fat and calories, and increase your activity level.

Most people who lose weight and keep it off do so by losing the weight slowly. They learn to make lasting changes. They eat fewer calories and stay physically active. You should try to lose 1 to 2 pounds (0.45–0.91 kg) each week until you reach a healthy weight.

204 Healthy Heart, Healthy Family: A Community Health Worker’s Manual for the Filipino Community

• Give group members the “Lola’s Tips To Help You Control Your Weight” handout (page 222). Review the tips for losing weight.

5. Beat Weight-Loss Barriers

• Ask:

Have any of you ever tried to lose weight?

• Ask people to share their experiences with the group. Ask them to tell what kept them motivated to lose weight.
• Ask:

Why do you think it is difficult for some people to lose weight or keep off the weight they lose?

Note: Write their answers on the blackboard or on a large piece of paper taped to the wall.

• Add some of the following answers if they are not mentioned.

Some people have a hard time losing weight because:

• They lack support from family members or friends.

• They attend many social gatherings and do not want to offend the host by not

enjoying the food.

• They believe that healthy foods are too expensive.

• They believe that healthy foods and healthy versions of Filipino recipes do

not taste good.

• Traditional Filipino foods are often high in fat and sodium.

• Some foods remind them of the Philippines, so they eat them even if they are

high in fat, cholesterol, and sodium.

• Leaving leftovers is a waste. Eating everything on the plate is common.

• It is hard to limit portions of rice.

Session 6. Keep the Beat: Aim for a Healthy Weight 205

• They believe that being heavy means a person is healthy or rich.

• Fast food and takeout food are convenient and affordable.

• Ask:

Have you found ways to beat these barriers to losing weight?

Note: Allow 3 to 5 minutes for group members to respond. Write their answers on the blackboard or on a large piece of paper taped to the wall.

• Add some of the following answers if they are not mentioned:

• Find another person who also wants to lose weight. You can talk with this

person to stay motivated.

• Walk or do other activities with another person. This makes it more fun, and

the time will pass more quickly.

• Find activities that the whole family can enjoy so they can control their

weight, too.

• Look for free or low-cost physical activity facilities at local community

centers or parks and recreation programs.

• Share cooking chores and recipes with friends. For example, if family

members will not eat lower-calorie dishes, make a dish and share it with a friend. Your friend can make a dish and share it with you.

Ask your doctor or a registered dietitian to help you develop a plan if you have a lot of weight to lose. Tell your doctor if you are taking any traditional medicines to help you lose weight.

• Show picture card 6.4.

Losing weight has become a moneymaking business. You hear about miracle diets that claim to help you lose weight quickly and easily. These products make only one thing lighter—and that’s your wallet. Be careful about ads that promote diets and exercise products using personal testimonies.

206 Healthy Heart, Healthy Family: A Community Health Worker’s Manual for the Filipino Community

Diets that promise quick weight loss rarely work. Many of these diets include only a few foods. People get bored with them quickly. These diets do not provide all the nutrients and energy your body needs. They are not healthy.

6. (Optional) A Visit From Back Home: Embracing a Balanced Lifestyle Role Play

• Give group members the “A Visit From Back Home: Embracing a Balanced Lifestyle Role Play” handout (page 223).
• Ask three volunteers to be actors for the role play. As the trainer, you can read the introduction.

Note: After the activity is completed, allow 5 minutes for discussion by asking the following questions.

• Ask:

• What are some of the lessons we learned from this role play?

• Is there any part of the play that you can use in your own life?

7. Serving Size Activity

Let’s look at how big a serving is. In Session 8, “Welcome Heart Healthy Eating Into Your Home,” we will look at how much you should eat.

Session 6. Keep the Beat: Aim for a Healthy Weight 207

Before the session

1. Check the “Serving Sizes” handout (page 224) for the serving size of each food. Measure one serving of each food, and put each in a separate dish or other container.
2. Place the dishes with these premeasured foods out of sight.
3. Place the box of dry oatmeal, a large bowl of steamed rice, a can of fruit or vegetables, a block of cheddar cheese, and a can of corned beef hash on a table with five dishes, four serving spoons, and a knife.

• Ask five volunteers to come to the table. Ask each volunteer to do one of the following:

1. Spoon out a serving of dry oatmeal, and put it on a dish.
2. Spoon out a serving of steamed rice, and put it on a dish.
3. Cut a serving of cheese, and put it on a dish.
4. Spoon out a serving of the fruit or vegetable, and put it on a dish.
5. Spoon out a serving of corned beef hash, and put it on a dish.

• Bring out the foods you measured before the session. Compare the volunteers’ serving sizes with the true amounts.
• Give group members the “Serving Sizes” handout (page 224). Ask volunteers to read aloud the serving sizes for each. Tell them to use this handout at home.

208 Healthy Heart, Healthy Family: A Community Health Worker’s Manual for the Filipino Community

8. Nutrition Facts Label Activity––Calories

Note: This activity will help group members choose foods that are lower in calories.

We have learned that to lose weight, a person must eat fewer calories than the body burns for energy. In the last session, you learned how to use the Nutrition Facts label to choose foods that are lower in saturated fat, trans fat, and cholesterol. Today, we are going to learn how to use the Nutrition Facts label to choose foods that are lower in calories.

• Show picture card 6.5.

Here’s where you can look to find the number of calories in one serving on the Nutrition Facts label. This Nutrition Facts label shows the number of calories in canned fruit cocktail in heavy syrup at the bottom of the handout.

• Give group members the “Read the Nutrition Facts Label for Calories!” handout (page 225).

Look at the Nutrition Facts labels for canned fruit cocktail in fruit juice and canned fruit cocktail in heavy syrup at the bottom of the handout. Which fruit cocktail has fewer calories?

Note: Allow 1 to 2 minutes for group members to respond.

Fruit cocktail in fruit juice has fewer calories. There are 60 calories in one serving, or ½ cup, of the fruit cocktail in fruit juice. There are 100 calories in one serving of the fruit cocktail in heavy syrup—almost twice as many calories as the fruit cocktail in fruit juice.

Session 6. Keep the Beat: Aim for a Healthy Weight 209

“Fat free” does not mean free of calories. You need to watch the calories and fat when comparing Nutrition Facts labels.

Here are a few examples:

Calories in reduced-fat food Calories in regular-fat food

Reduced-fat chocolate chip cookies, 118 Regular chocolate chip cookies, 142

Let’s try another group activity. I will tell you about a common problem for families today. Then we will learn how to use Nutrition Facts labels to help solve the problem.

• Give group members the “Lola’s Snack Choices” handout (pages 226–228). Read “Lola’s Family Eats Healthier Snacks” (page 211). Ask group members which foods Lola should serve.

210 Healthy Heart, Healthy Family: A Community Health Worker’s Manual for the Filipino Community

Lola’s Family Eats Healthier Snacks

Lola and her family like to have snacks when they watch television. Recently, Lola and Mila have noticed that their visiting family has gained too much weight. Use the Nutrition Facts labels to help choose some tasty snacks that are lower in calories. What should Lola serve? Write the number of your choice for each pair on the line. Then write the number of calories saved by this choice.

Note: The choices that are lower in calories are underlined below. The number of calories saved by making the right choice is given below each choice.

Shrimp-flavored crackers (1¼ cups) or air-popped popcorn (1 cup)? Choosing popcorn saves 129 calories.

Pineapple (½ cup) or a slice of bibingka? Choosing the pineapple saves more than 800 calories.

One cup of whole milk or one cup of fat-free (skim) milk? Choosing the fat-free (skim) milk saves 60 calories.

Ice cream (½ cup) or one popsicle? Choosing the popsicle saves 125 calories.

Canned fruit cocktail in fruit juice (½ cup) or canned fruit cocktail in heavy syrup (½ cup)? Choosing the fruit cocktail in fruit juice saves 40 calories.

Banana chips (1 ounce) or dried prunes (5 prunes)? Choosing the dried prunes saves 50 calories.

• Ask:

• What is an example of a higher-calorie snack that your family eats?

• What is an example of a lower-calorie snack that your family would enjoy?

Note: Allow a few minutes for group members to respond.

Session 6. Keep the Beat: Aim for a Healthy Weight 211

9. Lumpiang Sariwa (Fresh Lumpia) Recipe

• Give group members the “Lumpiang Sariwa (Fresh Lumpia) Recipe” handout (pages 229–230).

This is easy to make. It has only 112 calories and about 4 grams of fat per serving. It is also low in sodium. Try the recipe at home this week!

Review of Today’s Key Points

Let’s review what we learned today.

Why is it important to maintain a healthy weight?

• Being overweight may increase your risk of heart disease, high blood

pressure, high blood cholesterol, diabetes, and some types of cancer.

What is the healthiest way to lose weight?

• Eat smaller portions of a variety of foods lower in fat and calories, and

increase your physical activity.

How can the Nutrition Facts label help you if you need to lose weight?

• The Nutrition Facts label tells you the serving size and the number of

calories per serving. You can compare calories on different packages to choose foods that are lower in calories.

212 Healthy Heart, Healthy Family: A Community Health Worker’s Manual for the Filipino Community

Lola’s Life Lessons: A Time To Reflect

In the last session, Lola Idad reminded us that the steps to a healthy heart require discipline, which means taking control of your eating habits. This week, Lola encourages us to maintain a healthy weight. If you are overweight or obese, you can work toward a healthy weight by eating healthy, increasing physical activity, and losing weight slowly.

• Give each group member the “Lola’s Life Lessons: Session 6” handout (page 231). Ask a volunteer to read the handout.

Please take a few moments to reflect on Lola’s advice and how this applies to your life. At the bottom of the handout, there is a space called “A Time To Reflect.” Use this section to record your thoughts and feelings about this week’s session. Remember, this is for you and no one else.

• Give each group member 2 to 3 minutes to write down some thoughts.

Pledge for Life!

You have learned a lot today about losing weight the healthy way. Now, let’s think about how you can apply what you have learned. Please think of one change you can make in your everyday life to reach or keep a healthy weight.

Session 6. Keep the Beat: Aim for a Healthy Weight 213

Be specific about what you plan to do, how you plan to do it, and when you will start. Here are some examples:

• I will buy vegetable oil spray when I go to the grocery store next week. I

will use it instead of butter when I cook breakfast.

• I will walk for 30 minutes on most days during my lunch break at work,

starting tomorrow.

• I will eat only half of my entree the next time I eat out to cut down on my

food portion. I will take the other half home and save it for another meal.

• Give each group member the “Pledge for Life! Session 6” handout (page 232).

Take the pledge for life with Lola and her family. Take a step toward staying heart healthy and maintaining or reaching a healthy weight. Pledge to do one thing on this list during the coming week. Now, let’s start by sharing our goals with each other.

Note: Tell group members to be very specific about what they plan to do. (For example, if they say they will eat fewer calories, ask them to name some ways they can do this.) Give each group member 2 to 3 minutes to share.

We will discuss the results of your pledges next week. Don’t forget to continue working on your pledges to be more physically active and to cut back on salt, sodium, saturated fat, trans fat, and cholesterol.

214 Healthy Heart, Healthy Family: A Community Health Worker’s Manual for the Filipino Community

Closing

Thank you for coming today. What did you think of today’s session?

Note: Allow a moment for group members to respond.

I am looking forward to seeing you at the next session. The next session will be about diabetes and how it relates to heart disease.

Note for Educator: Think about today’s session. What worked and didn’t work? Have you made any changes in your own life to know and control the risk factors for heart disease that were covered in today’s session?

Session 6. Keep the Beat: Aim for a Healthy Weight 215

Body Mass Index (BMI) Chart

216 HANdOuT—SESSION 6

Body Mass Index (BMI) Chart

HANdOuT—SESSION 6 217

Do You Need To Lose Weight?

Let’s follow these steps to find out if you need to lose weight.

1. Learn if your weight is healthy. My weight is:

Weigh yourself. Use the BMI chart to find out whether your Healthy weight is in the healthy range for people your height. Find Overweight your weight on the top of the chart and circle it. Put your finger on the circled number, and lower your finger until you Obese find the line that corresponds to your height. The shade of your square will show if your weight level is healthy, overweight, or obese.

2. Measure your waist. Write down your waist measurement: _________

Measure your waist by Your waist measurement is high if:

placing the measuring • Women—Your waist measure is greater than 35 inches (88 cm).

tape snugly around your

• Men—Your waist measure is greater than 40 inches (102 cm).

waist. A high waist My waist measurement is: measure increases your risk for heart disease. Healthy High

3. Find out if you need to lose weight.

Check off your weight level below to find out if you need to lose weight.

Level Action

Healthy Weight • Good for you! Try not to gain any weight. Overweight • It is important not to gain more weight. • You need to lose weight if you are overweight and:

• You have two or more heart disease risk factors, or
• You have a high waist measurement.

• Ask your doctor or a registered dietitian for help. Obese • You need to lose weight. Lose weight slowly—about 1 to 2 pounds

(0.45–0.91 kg) a week. Ask your doctor or a registered dietitian for help.

218 HANdOuT—SESSION 6

Commit to Losing Weight: Make Long-Term Changes!

I used to weigh 150 pounds (68 kg). I was able to lose weight by eating smaller

Here is how

portions of the foods I like and walking

Lola Idad regularly. I also eat fewer fatty foods and

sweets and more fruits and vegetables.

found success. After I lost 20 pounds (9.1 kg), my blood

pressure went down. Now I stay at a healthy weight while still enjoying what I eat and walking on most days.

Try these tips to get started.

♥ Eat fewer foods that are high in ♥ Make stews with lean meat or skinless saturated fat—such as fried foods, pork poultry and vegetables. rinds, canned meats, and sausage. ♥ Serve small portions, and eat

♥ Cut down on cakes, pastries, candy, and soft drinks. ♥ Eat more fruits, vegetables, and whole grains.

salad if you are still hungry. Do not skip meals. ♥ Aim for 60 minutes of physical activity each day.

Make your personal pledge to do what the de la Cruz family is doing! Look at these examples:

When shopping

Read labels to choose foods lower in calories.

When cooking

Bake, steam, broil, or grill fish instead of frying it. Use vegetable oil spray instead of greasing the pan with oil or shortening.

When eating

Have green beans and steamed rice with one piece of chicken instead of three pieces of chicken alone.

Get active

If pressed for time, walk for 20 minutes three times a day: before work, during lunch, and with the family after dinner.

Your health and that of your family is priceless. Value it!

HANdOuT—SESSION 6 219

Lola’s Habits and Her Weight

Eat big portions.

Eat moderate portions.

Eat small portions.

Not being physically active. Gain weight.

Be physically active most days. Maintain weight.

Be physically active most days. Lose weight.

HANdOuT—SESSION 6

Mga Kinagawian ni Lola at Kanyang Timbang

Kumain ng mga malalaking takal.

Kumain ng mga katamtaman na laki na takal.

Kumain ng mga maliliit na takal.

Hindi pagiging aktibong pisikal. Pagiging aktibong pisikal sa nakararaming mga araw.

Madadagdagan ang timbang. Mananatili ang timbang.

Pagiging aktibong pisikal sa Mababawasan ang nakararaming mga araw. timbang.

HANdOuT—SESSION 6 221

Lola’s Tips To Help You Control Your Weight

1. Choose foods low in fat and low in calories. Try:

♥ Fat-free milk or low-fat (1%) milk instead of whole milk or coconut milk

♥ Cheeses marked “fat free” or “low fat” on the package

♥ Canned food labeled “light” or “lite”––Read the Nutrition Facts label!

♥ Fruits and vegetables without butter or sauce—Fruits and vegetables are low in calories and help you feel fuller.

♥ Steamed rice, cereals, and whole-grain noodles (pasta)

♥ Lean cuts of meat, seafood, and skinless chicken

♥ Water or low-calorie drinks instead of soft drinks and sugar-filled fruit drinks

2. Make foods the healthy way.

♥ Bake, steam, broil, or grill instead of frying foods.

♥ Prepare rice without lard or fatty meats.

♥ Use less high-fat cheese, lard, coconut oil, and butter when cooking.

♥ Use vegetable oil spray or a little bit of vegetable oil or tub margarine when cooking.

♥ Flavor salads with fat-free or low-fat mayonnaise or salad dressing.

♥ Marinate meats, poultry, and fish in a mixture of juice, garlic, onions, and herbs.

3. Limit your portion size.

♥ Serve smaller portions, and do not have second helpings. Have a salad if you are still hungry.

♥ Eat smaller meals and snacks throughout the day instead of having one big meal.

♥ When eating out, watch your portion sizes. Many restaurants now serve food portions that are too big. Share an entree, or bring half home.

♥ Go to buffets less often. Order from the menu.

♥ If you drink fruit juice, make sure it is 100 percent fruit juice. Keep an eye on the portion size. The calories in beverages add up quickly.

4. Get active! Say goodbye to excuses!

♥ Do your favorite physical activity for at least 60 minutes each day.

Try this: If you are pressed for time, walk for 20 minutes three times a day.

5. Aim for a healthy weight.

♥ Try not to gain extra weight. If you are overweight, try to lose weight slowly. Lose about 1 to 2 pounds (0.45–0.91 kg) a week. Losing even 10 pounds (4.5 kg) can help reduce your chances of developing heart disease.

u

A Visit From Back Home: Embracing a Balanced Lifestyle Role Play

Leticia (“Letty”), Lola’s youngest daughter, is visiting the United States from the Philippines. During her 2-week visit, Leticia begins learning tips for heart healthy living from her mother and family. Lola, Leticia, and Victoria (Lola’s friend and walking partner) are taking their daily morning walk in the park.

Victoria: Letty, it is good you are walking with us! You look like you have gained some weight, and you need to get moving!

Leticia: No, Tita,* I am just really healthy! Actually, I want to lose some weight, but I do not have the time to cook healthy or to work out. I am really busy at work these days.

Lola: Anak,† even when I went back home last year, you were a lot slimmer. You tend to eat a lot when you are under stress. You have to be careful since our family has a history of heart disease and overweight. Even your brothers did not begin taking care of themselves until after they got sick. Look at your Mama. If I can lose weight, then you can, too.

Leticia: You do look healthy, Mama. I just had a checkup, and my BMI and waist measurement are high. The nurse said that my high BMI and the extra inches around my waist put me at higher risk for heart disease.

Lola: Just remember that a balanced lifestyle is important. Why would you pay more attention to your work than to your health?

Leticia: You are right, Mama.

Lola: You are still young, anak! You should have a lot of energy.

Leticia: Okay, okay! I will start by joining your daily walks and learn some new recipes while I am here. One step at a time, right?

Victoria: Do not worry, Idad! I know she will make us proud.

• Tita means “auntie” in Tagalog. †Anak means “child” in Tagalog.

HANdOuT—SESSION 6 223

Serving Sizes

Food Group

Grains*

Vegetables

Fruits

Fat-free or low-fat milk and milk products

Lean meats, poultry, and fish

Nuts, seeds, and legumes

Fats and oils

Sweets and added sugars

Serving Sizes

1 slice bread 1 ounce dry cereal†

/2 cup steamed rice, cooked pasta, or cereal

1 cup raw leafy vegetable /2 cup raw or cooked vegetable, cut up /2 cup vegetable juice

1 medium piece of fruit /4cup dried fruit /2 cup fresh, frozen, or canned fruit /2 cup fruit juice

‡

1 cup fat-free or low-fat milk or yogurt 1/2 ounces cheese

1 ounce cooked (not fried) meat, poultry without the skin, or fish 1 egg§

1 1

/3 cup or 1/2 ounces nuts 2 tablespoons peanut butter 2 tablespoons or /2 ounce seeds /2 cup cooked legumes (dry beans and peas)

1 teaspoon tub margarine 1 teaspoon vegetable oil 1 tablespoon low-fat or fat-free mayonnaise 2 tablespoons low-fat or fat-free salad dressing

1 tablespoon sugar 1 tablespoon jelly or jam /2 cup sorbet, gelatin 1 cup lemonade

Whole grains are recommended for most grain servings as a good source of fiber and nutrients..

1 1

† Serving sizes vary between /2 cup and 1/3 ‡

cups, depending on cereal type. Check the product’s Nutrition Facts label. There are lactose-free alternatives available for people who are lactose intolerant. Limit the number of egg yolks to four per week.

HANdOuT—SESSION 6

Read the Nutrition Facts Label for Calories!

Nutrition Facts labels tell you what you need to know about choosing foods that are lower in calories. Here is a Nutrition Facts label for a can of fruit cocktail in fruit juice.

Canned Fruit Cocktail (in fruit juice)

Nutrition Facts

Serving Size ½ cup (110g) Servings Per Container 3.5

Amount Per Serving

Amount Per Serving

Serving Size and Number of Servings The serving size is ½ cup. There are 3½ servings in the can.

Calories from Fat 0

The nutrient amounts are for

% Daily Value*

one serving. So, if you eat

Sodium 10mg

two servings. You would

Total Carbohydrate 15g

need to double the amount of

Dietary Fiber 1g

calories on the label.

Sugars 14g Protein 0g

0% Calories

0%

The amount of calories in one serving is given here.

0% 0% 5% 4%

Sugar The amount of sugar is shown here.

Vitamin C 4%

Calcium 0% • Iron 2%

The Choice Is Yours— Calories 60 Calories from Fat 0 Compare! % Daily Value*

Total Fat 0g 0%

Which one would you Saturated Fat 0g 0%

Trans Fat 0g

choose?

Cholesterol 0mg 0% Sodium 10mg 0%

Canned fruits packed in syrup have added calories. Read the

Calories 100 Calories from Fat 0

Nutrition Facts label to choose fruits packed in fruit juice for a

% Daily Value*

lower-calorie snack or dessert. Total Fat 0g 0%

Saturated Fat 0g 0% Trans Fat 0g Cholesterol 0mg 0% Sodium 10mg 0%

Canned Fruit Cocktail (in Fruit Juice) Canned fruit cocktail in fruit juice has 60 calories in a ½-cup serving.

Canned Fruit Cocktail (in Heavy Syrup) Canned fruit cocktail in syrup has 100 calories in a ½-cup serving— almost twice the calories found in a ½-cup serving of canned fruit cocktail in fruit juice. This is an important difference when trying to lose weight or maintain a healthy weight.

are based on a 2,000-calorie diet. Your Daily Values may be higher or lower depending on your calorie needs.

HANdOuT—SESSION 6

Lola’s Snack Choices

Lola and 1 – Shrimp-flavored Crackers her family

Nutrition Facts

like to have Serving Size 1¼ cup (30g)

Servings Per Container 2.5

snacks when they watch Amount Per Serving television.

Calories160 Calories from Fat 60

Recently, she and Mila have % Daily Value* Lower

calorie

noticed that Total Fat 7g 11%

choice

the family has Saturated Fat 3g 15%

Trans Fat 0g ______

gained too

Cholesterol 0mg 0%

much weight.

Sodium 260mg 11% Number Total Carbohydrate 21g 7% of calories

Use the

Dietary Fiber 1g 4% saved

Nutrition Facts

Sugars 1g ______

labels to choose Protein 2g some tasty

Vitamin A 0% • Vitamin C 0%

snacks that

Calcium 2% • Iron 0%

are lower in calories. What should the family eat? 3 – Apple

Write the Nutrition Facts

Serving Size 1 medium (154g)

number of

Servings Per Container 1

your choice for

Amount Per Serving

each pair in the space between Calories 80 Calories from Fat 5 the labels.

% Daily Value*

Then write Lower

Total Fat 0g 1%

the number of calorie

Saturated Fat 0g 0% choice

calories saved

Trans Fat 0g ___

by this choice. Cholesterol 0mg 0%

Sodium 920mg 0% Number Total Carbohydrate 0 g 8% of calories Dietary Fiber 0g 16% saved Sugars 20g Protein 0g ______

Vitamin A 0% • Vitamin C 6% Calcium 0% • Iron 0%

2 – Popcorn (Air Popped)

Nutrition Facts

Serving Size 1 cup (8g) Servings Per Container 4

Amount Per Serving

Calories 30 Calories from Fat 0

% Daily Value*

Total Fat 0g 0% Saturated Fat 0g 0% Trans Fat 1g

Sugars 0g Protein 1g

Vitamin A 0% • Vitamin C 0% Calcium 0% • Iron 0%

4 – Bibingka (Sweet Rice Cake)

Nutrition Facts

Serving Size 1 slice (273g) Servings Per Container 4

Amount Per Serving

Calories890 Calories from Fat 460

% Daily Value*

Total Fat 51g 78% Saturated Fat 37g 185% Trans Fat 0g

Sugars 44g Protein 15g

Vitamin A 17% • Vitamin C 3% Calcium 105% • Iron 21%

are based on a 2,000-calorie diet. Your Daily Values may be higher or lower depending on your calorie needs.

226 HANdOuT—SESSION 6

Lola’s Snack Choices

5 – Whole Milk

Nutrition Facts

Serving Size 236mL (1 cup) Servings Per Container 16

Amount Per Serving

Calories150 Calories from Fat 70

% Daily Value*

Total Fat 8g 12% Saturated Fat 5g 25% Trans Fat 0g

Sugars 11g Protein 8g

Vitamin A 6% • Vitamin C 4% Calcium 30% • Iron 0% • Vitamin D 25%

7 – Chocolate Ice Cream

Nutrition Facts

Serving Size ½ cup (66g) Servings Per Container 16

Amount Per Serving

Calories170 Calories from Fat 80

% Daily Value*

Total Fat 9g 14% Saturated Fat 6g 30% Trans Fat 0g

Sugars 17g Protein 2g

Vitamin A 4% • Vitamin C 0% Calcium 6% • Iron 4%

6 – Fat-Free Milk

Nutrition Facts

Serving Size 236mL (1 cup) Servings Per Container 16

Amount Per Serving

Calories 90 Calories from Fat 0

% Daily Value*

Lower Total Fat 0g 0% calorie Saturated Fat 0g 0% Trans Fat 0g choice Cholesterol 5mg 2% ___ Sodium 125mg 5% Total Carbohydrate 12g 4% Number Dietary Fiber 0g 0% of calories Sugars 11g saved Protein 8g ___

Vitamin A 10% • Vitamin C 4% Calcium 30% • Iron 0% • Vitamin D 25%

8 – Popsicle

Nutrition Facts

Serving Size 1 popsicle (88g) Servings Per Container 12

Amount Per Serving

Calories 45 Calories from Fat 80

% Daily Value*

Lower Total Fat 0g 0% calorie Saturated Fat 0g 0% choice Trans Fat 0g ______ Cholesterol 0mg 0% Sodium 40mg 2% Total Carbohydrate 11g 4% Number Dietary Fiber 0g 0% of calories Sugars 11g saved Protein 0g ___

Vitamin A 0% • Vitamin C 0% Calcium 0% • Iron 0%

are based on a 2,000-calorie diet. Your Daily Values may be higher or lower depending on your calorie needs.

u

Lola’s Snack Choices

9 – Canned Peaches (in Fruit Juice)

Nutrition Facts

Serving Size ½ cup (110g) Servings Per Container 4

Amount Per Serving

Calories 50 Calories from Fat 0

% Daily Value*

Total Fat 0g 0% Lower Saturated Fat 0g 0% calorie Trans Fat 0g choice Cholesterol 0mg 0% ___ Sodium 25mg 1% Total Carbohydrate 13g 4% Number Dietary Fiber 1g 4% of calories Sugars 9g saved Protein 0g ___

Vitamin A 8% • Vitamin C 2% Calcium 0% • Iron 0%

11 – Banana Chips

Nutrition Facts

Serving Size 1 oz (308g) Servings Per Container 8

Amount Per Serving

Calories150 Calories from Fat 78

% Daily Value*

Number Dietary Fiber 1g 4% of calories Sugars 2g saved Protein 0g ___

Vitamin A 0% • Vitamin C 0% Calcium 2% • Iron 0%

10 – Canned Peaches (in Heavy Syrup)

Nutrition Facts

Serving Size ½ cup (110g) Servings Per Container 4

Amount Per Serving

Calories100 Calories from Fat 0

% Daily Value*

Total Fat 0g 0% Saturated Fat 0g 0% Trans Fat 0g

Sugars 23g Protein 0g

Vitamin A 2% • Vitamin C 2% Calcium 0% • Iron 0%

12 – Dried Prunes

Nutrition Facts

Serving Size 5 prunes (1.43 ounces) Servings Per Container 14

Amount Per Serving

Calories 45 Calories from Fat 0

% Daily Value*

Total Fat 0g 0% Saturated Fat 0g 0% Trans Fat 0g

Sugars 12g Protein 1g

Vitamin A 8% • Vitamin C 0% Calcium 2% • Iron 2%

are based on a 2,000-calorie diet. Your Daily Values may be higher or lower depending on your calorie needs.

SESSION

(Fresh

/2 cup cabbage, julienned /2 cup green beans, julienned /2 cup carrots, julienned /4 cup celery, julienned /4 cup jicama,* julienned /2 cup ground chicken or lean pork /2 cup shrimp, cleaned and deveined

wrappers or lumpia wrappers 2 cloves garlic, chopped /4 teaspoon salt /4 teaspoon pepper /3 cup dry roasted peanuts, chopped 1 tablespoon olive oil

1. Heat oil, and saute ground meat with

the shrimp and garlic.

1. Add vegetables until slightly crisp.

Pour in the chicken broth until cooked.

1. Season with salt and pepper.
2. Set aside, and drain in a colander.
3. Save the broth for the lumpia sauce.
4. Soak the Vietnamese spring roll

wrappers one at a time in water until soft and transparent. Dry immediately with a paper towel.

1. Lay the lettuce on the wrapper.
2. Place 2 tablespoons of the vegetable

mixture on the wrapper.

1. Fold in one side of the wrapper and

roll tightly.

1. Serve with lumpia sauce on top.

Sprinkle with chopped peanuts.

looks similar to a turnip or a large radish. The water chestnut can be used as an alternative.

Source: Philippine Heart Center’s Healthy Heart Cookbook.

SESSION

Lumpiang Sariwa Recipe

Lumpia Sauce

1 cup broth from the sauteed vegetables

1 tablespoon 1 tablespoon 3 cloves 1 teaspoon 2 tablespoons

light soy sauce brown sugar garlic, minced cornstarch cold water for mixing cornstarch

Quick Facts

Your family will love this tasty recipe. The ingredients—ground chicken or pork, olive oil, peanuts, and fresh herbs and spices—add flavor. Also, the lumpiang sariwa is served fresh so it has fewer calories than fried lumpiang.

1. Mix vegetable broth, soy sauce,

brown sugar, and garlic together, and bring to a boil.

1. Mix the cornstarch in 2 tablespoons

of cold water.

1. Slowly add the cornstarch

mixture to the broth. Stir until sauce thickens.

Yield: Serving size: 8 servings 1 lumpia Calories 160 Total Fat 4 g Saturated Fat 0.5 g Cholesterol 55 mg Sodium 150 mg Total Fiber 2 g Protein 10 g Carbohydrates 21 g Potassium 170 mg

, Heart Healthy Traditional Filipino Recipes, American Heart Association, 1999.

SESSION

Lola’s Life Lessons: Session 6

One of my favorite proverbs is:

“Ang buhay ay parang gulong minsang nasa ibabaw, minsang nasa ilalim.”

Translation: “Life is like a wheel; sometimes you are on top, sometimes you are on the bottom.”

Keeping your weight in the healthy range is important for heart health. Six months ago, our family set a goal. My kids made a pact to lose weight and live healthier lifestyles. Since I lost 20 pounds (9.1 kilograms) last year, my family sees that even old ladies like me can lose weight! They have helped me stay healthy, and now I am helping them.

Over the past few months, I have watched them struggle. I tell them that losing weight takes patience. Sometimes you are on top, and sometimes you are on the bottom. The key to losing weight is finding the right balance of physical activity and healthy eating.

Ang umaayaw ay di nagwawagi, ang nagwawagi ay di umaayaw. (“A quitter never wins, a winner never quits.”) It can be frustrating, because it takes time and commitment to

stay healthy.

Luckily, Mila helps me cook healthier meals, and Victoria is my faithful walking partner. I have found that if you have the patience and support of family and friends, you will find the right balance to help you achieve a heart healthy weight!

A Time To Reflect…

What keeps you from maintaining a healthy weight? What changes can you make to have a balanced life?

(Use this space to write down your thoughts for this week’s session.)

HANdOuT—SESSION 6 231

Pledge for Life! Session 6

Take the pledge for life with Lola Idad. Try to do at least one of these activities by yourself or share them with others.

Know your BMI number.

Know your waist measurement.

Know the appropriate serving sizes for food and drinks.

Shop for low-fat, low-calorie foods and drinks using the Nutrition Facts label.

Choose a variety of fruits (fresh, frozen, or canned in fruit juice) and unsalted nuts for healthy snacks.

Exchange heart healthy recipes with your friends and family.

Avoid taking second helpings of food.

When eating out, go to buffets less often. When getting carryout food, make healthy choices and select smaller serving sizes.

Support your friends and family in their efforts to maintain a healthy weight.

Other

232 HANdOuT—SESSION 6

s essi o n

Protect Your Heart: Prevent and Control Diabetes

Objectives

By the end of this session, group members will learn:

• What diabetes is and how it affects the body
• The symptoms of diabetes
• That diabetes is a major risk factor for heart disease
• The levels of blood glucose (blood sugar) and what they mean
• How to prevent and control diabetes
• The amount of sugar in common beverages

Materials and Supplies

To conduct this session, you will need:

• “Healthy Heart, Healthy Family” manual and picture cards
• Blackboard and chalk or several large pieces of paper, a marker, and tape
• Two clear plastic bottles of water*
• Red food coloring*

_______________

• Prepare before the session (see page 242).

Session 7. Protect Your Heart: Prevent and Control Diabetes 233

• 1 cup of corn syrup*
• A box of sugar cubes*
• Three manila file folders for activity display*
• Pictures of drinks listed on page 277*
• Glue*

(Optional) Note: Arrange for a health professional or a diabetes educator to come to the session to measure group members’ blood glucose levels.

Handouts

Give group members these handouts during this session:

• List of places where group members can get their blood glucose checked†
• “What Is Diabetes?” (page 260)
• “Are You at Risk for Type 2 Diabetes?” (page 261)
• (Optional) “Take These Small Steps Now To Prevent Diabetes” (page 262)
• (Optional) “Rose Learns About Preventing Diabetes” (page 263)
• “Symptoms of Diabetes” (page 264)
• “Be Good to Your Heart: Know Your Blood Glucose Level” (pages 265–266)
• “Tender Care for Your Feet” (page 267)
• “Be Smart About Your Heart: Control the ABCs of Diabetes” (pages 268–270)
• Read the Nutrition Facts Label for Sugar! (pages 271–273)
• Prepare before the session (see pages 242, 253, and 277). † Prepare this list before the session. You may find information at your local health department, hospital, or clinic.

234 Healthy Heart, Healthy Family: A Community Health Worker’s Manual for the Filipino Community

• Mila’s Food Choices (pages 274–276)
• Think Before You Drink: Hidden Sugar in Common Beverages (page 277)
• How Much Sugar and How Many Calories Are in Your Favorite Drink? (page 278)
• Pesang Isda (Fish Simmered With Ginger and Tomatoes) Recipe and Munggo Gisado (Sauteed Mung Beans) Recipe (pages 279–280)
• Lola’s Life Lessons: Session 7 (page 281)
• Pledge for Life! Session 7 (page 282)

Session Outline

Introducing the Session

1. Welcome
2. Review of Last Week’s Session
3. About This Session

Conducting the Session

1. The Facts Don’t Lie
2. What Is Diabetes?

What is Prediabetes?

1. Types of Diabetes
2. Risk Factors for Diabetes
3. Symptoms of Diabetes
4. Blood Glucose Levels

A. Hypoglycemia

B. Hyperglycemia

Session 7. Protect Your Heart: Prevent and Control Diabetes 235

1. Complications of Diabetes
2. ABCs of Diabetes Control
3. Nutrition Facts Label Activity––Sugar
4. Think Before You Drink––Hidden Sugar in Drinks Activity
5. Pesang Isda (Fish Simmered With Ginger and Tomatoes) and Munggo Gisado (Sauteed Mung Beans) Recipe Activity

Review of Today’s Key Points

Lola’s Life Lessons: A Time To Reflect

Pledge for Life!

Closing

Introducing the Session

1. Welcome

• Welcome group members to the session.

2. Review of Last Week’s Session

At the last session, we talked about aiming for a healthy weight.

236 Healthy Heart, Healthy Family: A Community Health Worker’s Manual for the Filipino Community

• Ask these questions:

Q: Does anyone remember why a healthy weight is important to your heart health?

A: Keeping a healthy weight reduces your risk of heart disease, stroke, high blood pressure, high blood cholesterol, and diabetes.

Q: What is the healthiest way to lose weight?

A: Eat smaller portions of a variety of foods lower in fat and calories, and increase your physical activity.

Q: How does the Nutrition Facts label help people who are trying to lose weight?

A: The Nutrition Facts label tells you the serving size and the number of calories in a serving.

At the end of last session, you made a pledge to do something to help you keep or reach a healthy weight. What problems did you have? How did you deal with any problems?

Note: Allow 2 minutes for group members to respond.

3. About This Session

In today’s session, we will learn what we can do to prevent and control diabetes. If you have diabetes, you will need to work closely with a doctor, a registered dietitian, or a certified diabetes educator to help you monitor and control your blood glucose.

Lola Idad’s family often thought that these changes were impossible, but Lola always reminds them that “Sa taong walang takot, walang mataas na bakod.” “To a fearless person, no fence is too high.”

Session 7. Protect Your Heart: Prevent and Control Diabetes 237

In this session, Lola’s family will share the lessons they have learned through their experiences, to help us on our journey to heart health.

Conducting the Session

1. The Facts Don’t Lie

• Diabetes is a serious problem for Filipino families. It affects men, women,

and children.

• A study in San Diego County found that one out of every three Filipinas

has diabetes.

• More than half of the Filipinas with diabetes do not know they have diabetes.

• Most Filipinas with diabetes (about 90 percent) are not obese (their BMIs are

less than 30 kg/m2).

• Diabetes is a chronic disease that slowly damages the body. Although it has

no cure, complications can be prevented.

• Diabetes is a major risk factor for heart disease.

2. What Is Diabetes?

Now we will talk about what diabetes is and the types of diabetes.

• Give group members the “What Is Diabetes?” handout (page 260).

238 Healthy Heart, Healthy Family: A Community Health Worker’s Manual for the Filipino Community

Diabetes happens when the body does not make enough insulin or cannot use it well, causing glucose to build up in the blood. Too much glucose in the blood is not good for your health. As a result, the body does not function well.

• Show picture card 7.1.

In a healthy body, the food we eat goes to the stomach, where it is digested. The food is broken down into blood glucose. Blood glucose is also called blood sugar.

The blood takes the glucose to the cells of your body, where it is turned into the energy needed for daily life. However, glucose cannot enter the cells alone. Insulin, a hormone made in the pancreas, helps glucose enter the cells.

• Show picture card 7.2.

Diabetes happens when the body does not produce enough insulin, or when the cells cannot use the insulin well. This means that the glucose cannot enter the cells and it builds up in the blood. People who have high levels of glucose in their blood have diabetes.

What Is Prediabetes?

• Ask:

What is prediabetes?

Note: Allow a minute for group members to respond.

Session 7. Protect Your Heart: Prevent and Control Diabetes 239

• Add these answers if they are not mentioned:

• Prediabetes is a condition in which blood glucose levels are higher than

normal, but not high enough to be diabetes.

• People with prediabetes are more likely to develop diabetes within the next

10 years.

• People with prediabetes are also more likely to have a heart attack or stroke.

3. Types of Diabetes

• Show picture card 7.3.

When a person does not have diabetes, the pancreas produces a healthy amount of insulin, which the body can use. This is shown in the first picture.

There are two main types of diabetes.

Type 1 diabetes:

• Happens when the pancreas no longer produces insulin. This is shown in the

second picture.

• Requires an insulin pump or shots every day.

• Is usually found in children, adolescents, or young adults.

• Affects about 5 to 10 percent of those with diabetes.

Type 2 diabetes:

• Happens when some insulin is produced, but the body cannot use it well.

This is shown in the third picture.

240 Healthy Heart, Healthy Family: A Community Health Worker’s Manual for the Filipino Community

• Happens more often in people who are overweight and are not

physically active.

• Is usually treated with diet pills or, sometimes, insulin shots.

• Can occur at any age, but is more common after age 40.

• Is increasing among children, especially if they are overweight.

• Affects 90 to 95 percent of people with diabetes.

Gestational diabetes is a special class of type 2 diabetes.

• Some pregnant women develop this kind of diabetes, but it usually disappears

after the baby is born.

• Overweight women and women who have a family history of diabetes are

also at higher risk for gestational diabetes.

• Women who have had gestational diabetes have a much higher chance of

developing type 2 diabetes later in life. Their children are also at a higher risk for becoming overweight and developing diabetes.

We have talked about healthy living throughout the sessions. Type 2 diabetes can be prevented and controlled by making healthy food choices, being physically active, and taking medication as prescribed by your doctor. If you have diabetes, it is important to be under a doctor’s care and to check your blood glucose as your doctor tells you.

Now we are going to do an activity to better understand what diabetes is. We will see the difference between normal blood and blood with a high blood glucose level.

Session 7. Protect Your Heart: Prevent and Control Diabetes 241

Before the session:

Prepare the Blood Glucose Demonstration

1. Put two clear plastic bottles on the table.
2. Add 1 cup of water and 3 drops of red food coloring into one of the bottles. This represents blood with normal blood glucose.
3. Add 1 cup of corn syrup and 3 drops of red food coloring into the other bottle. This represents blood with high blood glucose.

• Show the plain water bottle, and slowly tilt it from side to side to show the smooth movement of the liquid.

Notice how the liquid moves easily and freely. This represents the blood of someone with normal blood glucose.

• Show the bottle with corn syrup, and slowly tilt the bottle from side to side to show the slow movement of the liquid.

Notice how slowly the blood moves and how thick it is when the blood glucose level is high. This represents the blood of someone with high blood glucose. The glucose stays in the blood instead of being used by the body’s cells and muscles.

4. Risk Factors for Diabetes

• Ask:

What are some risk factors that increase your chances of getting diabetes?

Note: Allow about 3 minutes for group members to respond. Write their answers on the blackboard or on a large piece of paper taped to the wall.

242 Healthy Heart, Healthy Family: A Community Health Worker’s Manual for the Filipino Community

• Show picture card 7.4.
• Give group members the “Are You at Risk for Type 2 Diabetes?” handout (page 261). As you read each risk factor, ask group members to make a checkmark next to the risk factors they have.

Your chances of getting diabetes increase if you:

• Are overweight, especially if you have extra weight around the waist.

• Have a parent or sibling with diabetes.

• Are Asian American, Native Hawaiian or other Pacific Islander, African

American, Latino, or American Indian.

• Have had gestational diabetes or have given birth to at least one baby

weighing more than 9 pounds (4.1 kg).

• Have blood pressure that is 140/90 mmHg (millimeters of mercury) or higher

or have been told by a health care provider that you have high blood pressure.

• Have cholesterol levels that are not normal, that is, a level of HDL (high-

density lipoprotein) cholesterol (“good” cholesterol) of 35 mg/dL (milligrams per deciliter) or lower, or a triglyceride level of 250 mg/dL or higher.

• Are not very active (participate in physical activity less than three times

a week).

The good news is that, if you are at risk for diabetes, you can prevent or delay getting diabetes by being physically active and having a healthy weight.

It is important to be physically active for 30 minutes on most days and to lose even a small amount of weight. For example, someone who weighs 200 pounds (90.7 kg) would benefit from losing 10 to 15 pounds (4.5 to 6.8 kg).

Session 7. Protect Your Heart: Prevent and Control Diabetes 243

• (Optional) Give group members the “Take These Small Steps Now To Prevent Diabetes” handout (page 262). Review the handout with the group.
• (Optional) Give group members the “Rose Learns About Preventing Diabetes” handout (page 263). Ask for three volunteers to read the role play. As the trainer, you can read the introduction.

Note: Allow 5 minutes for discussion.

• Ask the following questions:

• What are some of the lessons we learned from this role play?

• Is there any part of the play that you can use in your own life?

5. Symptoms of Diabetes

• Ask:

Does anyone know the signs or symptoms of diabetes?

Note: Allow 3 to 5 minutes for group members to answer.

• Give group members the “Symptoms of Diabetes” handout (page 264).
• Show picture card 7.5.

Now let’s review the symptoms of diabetes:

• Feeling tired
• Increased thirst
• Frequent urination
• Increased hunger
• Unexplained weight loss
• Very dry skin
• “Pins and needles” feeling in feet
• Sores that don’t heal
• Blurry vision
• Feeling irritable

244 Healthy Heart, Healthy Family: A Community Health Worker’s Manual for the Filipino Community

Often, people with type 2 diabetes have no symptoms. If you have one or more symptoms, see your doctor right away.

6. Blood Glucose Levels

• Show picture card 7.6.

To find out if you have diabetes, you can take a fasting blood glucose test at the doctor’s office or at a lab.

• Give group members the “Be Good to Your Heart: Know Your Blood Glucose Level!” handout (pages 265–266).

• A fasting blood glucose level below 100 mg/dL is normal. You are in

good shape.

• A fasting blood glucose level of 100 to 125 mg/dL is prediabetes. This is a

warning that you are at risk for developing type 2 diabetes. It is time to lose weight and be physically active at least 5 days a week.

• A fasting blood glucose level of 126 mg/dL or higher means that you have

diabetes. If you have diabetes, you should work with your doctor and other health care providers to learn to control it. It is important to work with your doctor to learn the ABCs (A1C test, blood pressure, and cholesterol) of controlling diabetes. We will learn about the ABCs of diabetes control later in this session.

You can also get a nonfasting glucose test at health fairs and other sites in your community. This is done using a glucometer and a small amount of blood. A nonfasting blood glucose level of 200 mg/dL or higher could mean that you have diabetes. See your doctor to get a fasting blood glucose test. You must fast for at least 8 hours before the test.

Session 7. Protect Your Heart: Prevent and Control Diabetes 245

More Information: Fasting Blood Glucose Levels

Fasting Blood 1 –2 Hours Level Glucose After Meals Results

Normal 70–99 mg/dL 70–139 mg/dL Good for you!

Prediabetes 100–125 mg/dL 140–199 mg/dL This is a warning that you are at risk for type 2 diabetes. A blood glucose level in this range is higher than normal, but not high enough to be diabetes. You need to take action to prevent diabetes.

Diabetes 126 mg/dL or 200 mg/dL or You have diabetes. Work with higher higher your doctor and other health care providers to control the ABCs (A1C, blood pressure, and cholesterol).

People with diabetes may experience problems if their blood glucose levels get too low or too high.

A. Hypoglycemia

Hypoglycemia is a condition that develops when a person’s blood glucose level is too low. People with diabetes may develop hypoglycemia.

People with diabetes may develop hypoglycemia when they:

• Skip or delay a meal or eat very little.

• Take too much insulin or oral diabetes medicine.

246 Healthy Heart, Healthy Family: A Community Health Worker’s Manual for the Filipino Community

• Do too much physical activity.

• Drink alcohol.

The symptoms of hypoglycemia are:

• Headache

• Feeling shaky

• Feeling anxious

• Dizziness

• Feeling weak

• Feeling irritable

People with diabetes should talk to their health care providers to learn what to do for low blood glucose.

People with diabetes may suffer from hypoglycemia. If your blood glucose is below 70 mg/dL, your health care provider may tell you to do one of the following:

• Drink ½ cup of fruit juice.

• Drink 1 cup of milk.

• Take two to three glucose tablets.

• Eat 2 teaspoons of sugar or honey.

Session 7. Protect Your Heart: Prevent and Control Diabetes 247

B. Hyperglycemia

Hyperglycemia is a condition that occurs when a person’s blood glucose level is too high. People with diabetes may develop hyperglycemia when they:

• Eat too much food.

• Are less active than usual.

• Have not taken their medicine.

• Are sick or feel tension and stress.

The symptoms of hyperglycemia are:

• Increased thirst

• Frequent urination

• Dry skin

• Increased hunger

• Blurry vision

• Feeling tired

• Nausea

People with diabetes should talk to their health care providers about what to do if they experience the effects of high blood glucose.

If your blood glucose is too high, your health care provider may need to change your medication or eating plan.

248 Healthy Heart, Healthy Family: A Community Health Worker’s Manual for the Filipino Community

7. Complications of Diabetes

Diabetes can cause changes in the body. These changes can cause problems, called complications. Can anyone name any complications of diabetes?

Note: Allow 3 to 5 minutes for group members to respond. Write their answers on the blackboard or on a large piece of paper taped to the wall.

Over time, diabetes can affect the large blood vessels in the brain, heart, legs, and feet. It also can affect the small blood vessels in the kidneys and eyes. Diabetes can lead to:

• Heart attack

• Stroke

• Amputation of the feet or legs—Diabetes can cause nerve damage. The first

sign of nerve damage is the loss of sensation in the feet or legs. If you have nerve disease, you may lose feeling or have tingling or pain in your toes, feet, or legs.

• Kidney disease—With diabetes, the excess glucose in the blood damages

the blood vessels inside the kidneys. Filipino Americans are four times more likely than Caucasians to develop kidney failure, the final stage of kidney disease.

• Eye disease—Diabetes can harm your vision or even cause blindness. People

with diabetes need to have their eyes examined by a medical eye doctor once a year.

• Dental problems—An increase in cavities and tooth infections is common in

people with poor diabetes control. To prevent tooth decay, brush and floss your teeth every day. See your dentist every 6 months.

Session 7. Protect Your Heart: Prevent and Control Diabetes 249

Over time, diabetes can affect all parts of the nervous system. This can lead to:

• Loss of strength in muscles

• Changes in digestion, bladder control, and sexual function

• Loss of feeling in the feet—This is why you need to keep your feet clean,

dry, soft, and protected.

• Give and review the “Tender Care for Your Feet” handout (page 267).

8. ABCs of Diabetes Control

If you have diabetes, controlling your blood glucose levels can help prevent or delay complications.

We’ve learned that people with diabetes have a greater chance of having a heart attack or stroke. Let’s find out how to take care of the heart with the ABCs of diabetes control.

• Give and review the “Be Smart About Your Heart: Control the ABCs of Diabetes” handout (pages 268–270).

Be sure to ask your doctor:

• What are my ABC numbers?

• What should my ABC numbers be?

• What actions should I take to control my ABC numbers?

250 Healthy Heart, Healthy Family: A Community Health Worker’s Manual for the Filipino Community

Knowing about diabetes can help prevent or delay it. For those who already have diabetes, diabetes education can help reduce the complications the disease can cause.

9. Nutrition Facts Label Activity—Sugar

People with diabetes should control their sugar intake, because sugar is high in calories and contributes to weight gain. Eating too much sugar can also lead to increased blood glucose levels in those with diabetes.

Now let’s do an activity that will help us use Nutrition Facts labels to find foods that have less sugar.

• Give group members the “Read the Nutrition Facts Label for Sugar!” handout (pages 271–273).

This handout shows the amount of sugar in some drinks and food. Look at the bottom of the handout. Which drink has fewer grams of sugar—mango nectar or unsweetened iced tea?

The iced tea has less sugar. One cup of mango nectar has 50 grams of sugar, compared to 0 grams of sugar in 1 cup of unsweetened iced tea.

Note: Unlike other nutrients, sugar does not have a Percent Daily Value on the Nutrition Facts label.

Let’s try another activity. Mila needs our help.

Session 7. Protect Your Heart: Prevent and Control Diabetes 251

• Give group members the “Mila’s Food Choices” handout (pages 274–276).

First, I am going to read about Mila’s problem. Then we will use the Nutrition Facts labels to find some solutions.

Mila’s Food Choices

Mila has offered to go grocery shopping for her mother, Lola Idad, who is home sick with the flu. Lola also has diabetes. Mila wants to buy foods that are lower in calories and sugar to help her mother. Look at the Nutrition Facts labels. Help Mila select foods that are lower in sugar. Which foods should Mila buy? Write the number of your choice for each pair. Then write the number of grams of sugar saved by this choice.

Note: The correct answers to the questions are underlined. The sugar and calories saved by making the right choice are given below the choices.

Pan de Sal (Filipino roll) or a doughnut Choosing the pan de sal saves 14 grams of sugar.

Gelatin or sugar-free gelatin Choosing the sugar-free gelatin saves 19 grams of sugar.

Regular ice cream or fat-free, no-sugar-added ice cream Choosing the fat-free, no-sugar-added ice cream saves 90 calories.

Diet soda or regular soda Choosing diet soda saves 39 grams of sugar.

Bibingka (sweet rice cake) or cooked oatmeal Choosing the cooked oatmeal saves 44 grams of sugar.

252 Healthy Heart, Healthy Family: A Community Health Worker’s Manual for the Filipino Community

10. Think Before You Drink—Hidden Sugar in Drinks Activity

Note: Prepare before the session.

1. Look at the box that appears below. Use drawings or empty cans or bottles to represent these drinks.
2. Prepare five separate displays for each of the five drinks.
3. Follow these instructions to prepare each display:

• Cut a folder into two parts, folding each part in half to make a card (tent).

• Write the name of the drink on one side. On the other side, write the number

of calories, grams of sugar, and teaspoons of sugar in the drink. Glue the cubes of sugar onto the folder to show the number of teaspoons of sugar in each drink. To get the number of teaspoons, divide the grams of sugar on the food label by four. Examples of the displays are shown on page 277.

1. Hide the displays until it is time to do the activity.

Serving Size Drink Amount of Sugar

12 ounces Powdered drink mix 9 teaspoons (36 grams) with sugar

Session 7. Protect Your Heart: Prevent and Control Diabetes 253

Group Activity

We are going to play a guessing game to learn how much sugar is in some common beverages.

• Give group members the “Think Before You Drink—Hidden Sugar in Common Beverages” handout (page 277).
• Show group members the front of each of the five cards that you prepared before the session, showing them the names of the beverages.

Guess how many teaspoons of sugar are in each drink. Write your answers on the handout I gave you.

Note: Allow 2 minutes for group members to write down their answers.

• Ask group members to share the amounts of sugar that they guessed. After the group members have shared the amounts they guessed, show them the actual number of teaspoons of sugar that are in each drink. Pass around the cards one by one.

During the second part of this activity, you will learn how much sugar and calories are in your favorite drink.

• Give group members the “How Much Sugar and How Many Calories Are in Your Favorite Drink?” handout (page 278).

Find your favorite drink on the list. Look to see how much sugar and how many calories are in it. Many drinks have a high amount of sugar and calories.

254 Healthy Heart, Healthy Family: A Community Health Worker’s Manual for the Filipino Community

As you can see, it is easy for people who choose drinks with sugar to get too many calories. Getting too many calories leads to weight gain. Try to drink more water or unsweetened drinks instead of drinks with sugar or regular sodas.

11. Pesang Isda (Fish Simmered With Ginger and Tomatoes) and Munggo Gisado (Sauteed Mung Beans) Recipe Activity

With simple changes to traditional foods, Lola Idad and her family learned that heart healthy Filipino food tastes good.

• Give group members the following recipe handouts: “Pesang Isda (Fish Simmered With Ginger and Tomatoes) Recipe” and “Munggo Gisado (Sauteed Mung Beans) Recipe” (pages 279–280). Ask them to prepare one or more of them during the coming week. Tell them that using the recipes will give them a chance to practice some of the ideas from the session.
• Ask:

How are these recipes heart healthy?

• Add the answers below if they are not mentioned:

• The main dish is made with fish.

• The side dish is made with vegetables, seafood, and lean meat.

• The fish is simmered in water, not fried.

• No fat is added to the fish and only a tablespoon of corn oil is added to the

mung beans.

• Additional flavoring with herbs and spices
• Cooked and simmered slowly in moist heat

Session 7. Protect Your Heart: Prevent and Control Diabetes 255

Remember that foods lower in fat still contain calories. Check the portion size. If you eat these foods in large quantities, you may gain weight.

Review of Today’s Key Points

Let’s review what we learned today.

What is diabetes?

• Diabetes happens when the body does not make enough insulin or cannot use

it well, causing glucose to build up in the blood. As a result, the body does not function well.

What are risk factors for diabetes?

• Overweight

• Family members with diabetes

• Age 40 or older

• Not being physically active

• Being Latino, African American, American Indian, Asian American, or Native

Hawaiian or other Pacific Islander (because diabetes occurs more often in people from these groups than in Caucasians)

• Having had gestational diabetes or given birth to at least one baby weighing

9 pounds (4.1 kg) or more

• High blood pressure

• Cholesterol levels are not normal—HDL cholesterol is low or triglycerides

are high

256 Healthy Heart, Healthy Family: A Community Health Worker’s Manual for the Filipino Community

How can you prevent or delay type 2 diabetes?

• Be physically active for 30 minutes on most days.

• Lose a small amount of weight. For example, losing 10 to 15 pounds (4.5 to

6.8 kg) is helpful for someone who weighs 200 pounds (90.7 kg).

What are the ABCs of diabetes control?

• A is for the A1C test. If you have diabetes, take the A1C blood test at least

two times every year. This test measures how well a person’s blood glucose level has been controlled over the past 3 months. People who have diabetes should aim for an A1C number that is below seven.

• B is for blood pressure. High blood pressure makes your heart work too

hard. It increases your risk for a heart attack, stroke, or damage to your kidneys and eyes. A person with diabetes should have a blood pressure below 130/80 mmHg.

• C is for cholesterol. Keep cholesterol at normal levels. Bad cholesterol

(LDL) can build up and clog your arteries. It can cause a heart attack. People with diabetes need to keep their LDL cholesterol below 100 mg/dL.

How does diabetes affect your body?

• Diabetes can cause damage to the heart, brain, kidneys, and eyes. It can

cause nerve damage, which reduces sensation in your feet. Diabetes may also affect blood flow in your legs and feet. This can lead to sores that don’t heal and amputation. Good control of your blood glucose can prevent this damage.

Session 7. Protect Your Heart: Prevent and Control Diabetes 257

Lola’s Life Lessons: A Time To Reflect

Like many families, the de la Cruz family needs to make lifestyle changes. Lola Idad’s kids are busy with work and making sure that their children are safe and well educated. Lola encourages her family to stay on the heart healthy path to help prevent their risk for diabetes. She and the family learn to prepare heart healthy meals and plan time for the family to be more physically active.

• Give each group member the “Lola’s Life Lessons: Session 7” handout (page 281). Ask a volunteer to read the handout.

Please take a few moments to reflect on Lola’s advice and how this applies to your life. At the bottom of the handout, there is a space called “A Time To Reflect.” Use this section to record your thoughts and feelings about this week’s session. Remember, this is for you and no one else.

Pledge for Life!

• Give each group member the “Pledge for Life! Session 7” handout (page 282).

Take the pledge for life with Lola Idad. She and her family have taken the pledge to lower their risk of getting diabetes. Take the step toward losing weight if overweight, eating healthy foods, getting regular physical activity, and keeping blood sugar within the normal range. Pledge to do one thing on this list during the coming week.

Note: Give each group member 2 to 3 minutes to share.

258 Healthy Heart, Healthy Family: A Community Health Worker’s Manual for the Filipino Community

We will talk about how you did with your pledges at the next session. Remember to keep working on your pledges to be more active.

• (Optional—if you can get a health professional to come to your session)
• Tell group members that a health professional will now check their blood sugar.

Closing

Thank you for coming today. What did you think of today’s session?

Note: Allow a moment for group members to respond.

I am looking forward to seeing you at the next session. The next session will be about making heart healthy eating an everyday family affair.

Note for Educator: Think about today’s session. What worked? What didn’t work? Have you made changes in your own life to prevent and control diabetes as a result of today’s session?

Session 7. Protect Your Heart: Prevent and Control Diabetes 259

What Is Diabetes?

Diabetes happens when the body does not make enough insulin or cannot use it well. This causes glucose to build up in the blood. As a result, the body does not function well.

Know your body

• The food we eat goes to the stomach,

Insulin where it is digested. The food is turned Glucose

The pancreas

into blood glucose in the body. Blood The stomach makes the

digests the insulin.

glucose is also called blood sugar. The food. body uses glucose to provide energy needed for daily life.

• The blood takes the glucose to the cells where it is turned into energy. However, glucose cannot enter the cells alone; it needs help. Insulin helps the glucose enter the cells. Insulin is a hormone that is made in the pancreas.
• If the body does not produce enough insulin, or if the cells cannot use the insulin well, then the glucose cannot enter the cells and it builds up in the blood.
• People who have high levels of glucose in their blood have prediabetes or diabetes.

260 HANDOuT—SeSSION 7

Are You at Risk for Type 2 Diabetes?

Name:

Check the risk factors you have. The more risk factors you check, the higher your risk for developing type 2 diabetes. Only your health care provider can determine if you have diabetes. On your next visit, find out for sure.

o I am overweight (especially if I have extra weight around the waist).

o I have a parent, brother, or sister with diabetes.

o My family background is Asian American, Native Hawaiian or other Pacific Islander, Latino, African American, or American Indian.

o I have had gestational diabetes, or I gave birth to at least one baby weighing 9 pounds (4.1 kg) or more.

o My blood pressure is 140/90 mmHg or higher, or I have been told by a health care professional that I have high blood pressure.

o My cholesterol levels are not normal. My HDL cholesterol (“good” cholesterol) is 35 mg/dL or lower, or my triglyceride level is 250 mg/dL or higher.

o I do very little physical activity. I exercise fewer than three times a week.

HANDOuT—SeSSION 7 261

Take These Small Steps Now To Prevent Diabetes

• Find out if you are at risk. Asian Americans and Native Hawaiians or other Pacific Islanders are at high risk for type 2 diabetes and are not always overweight. Talk to your health care provider about YOUR risk.
• Lose a small amount of weight. Being overweight puts you at high risk for type 2 diabetes. The weight you think is normal for you may not be a healthy weight. You can work toward a healthy weight by being more active and eating healthy.
• Be more physically active. Choose an activity you enjoy. Take a walk, swim, bike ride, dance, or play ball with your children.
• Eat healthy. Make healthy food choices and eat smaller servings. Cut down on fatty and fried foods. Choose more fruits and vegetables, dry beans, and whole grains.
• Record your progress. Every day, write down all the things you eat and drink and the number of minutes you are active. Keeping a diary is one of the best ways to lose weight and keep it off.
• Keep at it. Make one new change each week. If you get off track, start again, and keep going.

Source: Adapted from “Take These Small Steps Now To Prevent Diabetes,” National Diabetes Education Program, 2007.

262 HANDOuT—SeSSION 7

Rose Learns About Preventing Diabetes

Rose has just arrived at Mila’s house. She is upset because she has just been diagnosed with prediabetes. Mila and Lola are trying to comfort her.

Mila: Rose, are you okay? You look upset.

Rose: I just had a checkup with Dr. Cabaya, and he told me that I have prediabetes! How do I tell Jose? He will be upset.

Mila: My brother only wants to see you and the family healthy and strong— especially after his struggles with high blood pressure and his stroke. Think of this news in a positive way. You can still make changes now to delay or prevent diabetes.

Rose: I have been trying so hard to help Jose stay healthy and keep his blood pressure under control that I forgot about myself. But Dr. Cabaya told me that the whole family should be healthy, not just one person.

Lola: Rose, Dr. Cabaya is right. You have to stay healthy for your children and family! Remember how hard it was for Jose’s dad to change his habits when he was diagnosed with diabetes? He did not change his lifestyle, so the complications from the diabetes made his last years very hard.

Rose: Yes, Mama (Lola). Dr. Cabaya said I should be physically active every day, make wiser food choices, and lose some weight. He said this would help lower my blood sugar and reduce my risk for diabetes.

Mila: You are already helping Jose make heart healthy changes. It will be easier for you to practice these changes now, too. You could also start walking with Mama (Lola) and me on the weekends. It will be fun!

Rose: Yes, that’s a great idea. Maybe making these changes will not be too hard.

Lola: Have courage, Rose. Sa taong walang takot, walang mataas na bakod. “To a fearless person, no fence is too high.”

HANDOuT—SeSSION 7 263

Symptoms of Diabetes

The symptoms of type 2 diabetes develop over time. Some people have symptoms, and others do not. Here are some symptoms of diabetes.

Feeling tired

Increased thirst

Frequent urination

Sores that don’t heal

Very dry skin

“Pins and needles” feeling in the feet

Increased hunger Blurry vision

Unexplained weight loss Feeling irritable

264 HANDOuT—SeSSION 7

Be Good to Your Heart: Know Your Blood Glucose Level

Write your fasting blood glucose level here:

What does your blood glucose level mean?

Fasting blood glucose level (mg/dL):

Normal

Below 100 mg/dL — Good for you! Keep up the good work!

100 to 125 mg/dL Prediabetes

• You are at risk for developing type 2 diabetes.
• It is time to lose weight and be physically active at least 5 days a week.

126 mg/dL or higher Diabetes

• You should work with your doctor and other health care providers to learn to control it.
• You should work with your doctor to learn the ABCs (A1C test, blood pressure, and cholesterol) of controlling diabetes.

HANDOuT—SeSSION 7 265

Maging Mabuti sa Iyong Puso: Alamin ang Iyong Antas ng Asukal sa Dugo

Isulat ang iyong pag-aayuno sa antas ng asukal sa dugo dito:

Ano ang ibig sabihin ng iyong antas ng asukal sa dugo?

Antas ng pag-aayuno ng asukal sa dugo (mg/dL):

Mas mababa sa 100 mg/dL Normal

• Mabuti para sa iyo! Ipagpatuloy ang mabuting gawain!

100 hanggang 125 mg/dL Paunang diyabetis

• Nasa peligro ka ng pagbuo ng type 2 diyabetis.
• Oras na para magbawas ng timbang at maging aktibong pisikal ng hindi bababa sa 5 araw sa isang linggo.

126 mg/dL o mas mataas Diyabetis

• Dapat kang makipagtulungan sa iyong duktor at iba pang mga tagapagbigay ng pangangalaga sa kalusugan upang matutunang kontrolin ito.
• Dapat kang makipagtulungan sa iyong duktor upang matutunan ang mga ABC (pagsubok na A1C, presyon ng dugo, at kholesterol) ng pagkontrol ng diyabetis.

266 HANDOuT—SeSSION 7

Tender Care for Your Feet

Diabetes can cause nerve damage, which reduces sensation in your feet. Diabetes may also affect blood flow in your legs and feet, making it harder for cuts and sores to heal. Small injuries may become infected and can become very serious.

Daily care

o Wash your feet in warm water every day. Dry them carefully, especially between your toes.

o Look at your feet every day to check for cuts, sores, blisters, redness, calluses, or other

problems. If you cannot bend over or pull your feet up to check them, use a mirror, or ask someone else to check your feet.

o If your skin is dry, rub lotion on your feet after you wash and dry them. Do not put lotion

between your toes.

o Smooth corns and calluses gently with an emery board or pumice stone. Do this after your

bath or shower. Do not use a pocketknife or razor blade that can cut your skin.

o Cut your toenails once a week after a bath.

Periodic foot exam

o Remind the health care provider to check your feet at every visit.

o Get a complete foot exam once a year. If you have problems with your feet, have the health

provider check them every 3 to 6 months.

Footwear

o Wear well-cushioned shoes and socks at all times. Do not go barefoot.

o Change your socks every day, and make sure they are clean and soft.

o Buy shoes that are roomy and allow your feet to “breathe.”

o Medicare provides coverage of special shoes for people with diabetes. Check with your

doctor to see if you qualify.

HANDOuT—SeSSION 7 267

Be Smart About Your Heart: Control the ABCs of Diabetes

Some people have prediabetes, which is when blood glucose levels are higher than normal, but not in the diabetes range. People with this condition can reduce the risk of developing diabetes by losing a small amount of weight and increasing their physical activity.

If you have diabetes, controlling your blood glucose levels will help prevent complications.

The ABCs of Diabetes

If you have diabetes, three key steps can help you better manage your diabetes and lower your risk of heart attack and stroke. Follow these ABCs:

• A is for the A1C test, which is short for hemoglobin A1C. This test measures your average blood glucose over the previous 3 months. It lets you know if your blood glucose level is under control. Get this test at least twice a year. Number to aim for: below 7

Date

Result

• B is for blood pressure. The higher your blood pressure, the harder your heart has to work. Get your blood pressure measured at every doctor’s visit. Numbers to aim for: below 130/80 mmHg

Date

Result

• C is for cholesterol. Maintain a normal cholesterol level. “Bad” cholesterol, or LDL, builds up and clogs your arteries. Get your LDL cholesterol tested at least once a year. Number to aim for: below 100 mg/dL

Date

Result

Be sure to ask your doctor:

• What are my ABC numbers?
• What should my ABC target numbers be?
• What actions should I take to reach my ABC target numbers?

Write the changes you will make this week to control your blood glucose, blood pressure, or cholesterol.

(Date)

(Date)

HANDO

Maging Matalino sa Pangangalaga ng Iyong Puso: Kontrolin ang mga ABC ng Diyabetis

Ang ilang mga tao ay mayroong paunang diyabetis, na kapag ang mga antas ng asukal sa dugo ay mas mataas sa normal, ngunit hindi sa saklaw ng diyabetis. Ang mga taong may ganitong kundisyon ay maaaring bawasan ang peligro ng pagbuo ng diyabetis sa pamamgitan ng pagbabawas ng kaunting timbang at pagdaragdag ng kanilang pisikal na aktibidad.

Kung mayroon kang diyabetis, ang pagkontrol sa iyong antas ng asukal sa dugo ay makatutulong na maiwasan ang mga kumplikasyon.

Ang mga ABC ng Diyabetis

Kung mayroon kang diyabetis, ang tatlong pangunahing hakbang ay maaaring makatulong sa iyo na mahusay na mapamahalaan ang iyong diyabetis at babaan ang iyong peligro ng pagkakaroon ng atake sa puso at stroke. Sundin ang mga ABC na ito:

• Ang A ay para sa pagsubok na A1C, na pinaikling hemoglobin A1C. Sinusukat

ng pagsubok na ito ang iyong katamtamang asukal sa dugo sa nakaraang 3 buwan. Ipinapaalam nito sa iyo kung ang iyong antas ng asukal sa dugo ay nakokontrol. Kunin ang pagsubok na ito ng hindi bababa sa dalawang beses sa isang taon.

Bilang na dapat hangarin: mas mababa sa 7

Petsa

Resulta

• ■ ■ Ang B ay para sa presyon ng dugo. Kung mas mataas ang presyon ng iyong dugo,

mas magiging mahirap ang paggana ng iyong puso. Kunin ang presyon ng iyong dugo sa bawat pagbisita sa duktor.

Bilang na dapat hangarin: mas mababa sa 130/80 mmHg

Petsa

Resulta

HANDOuT—SeSSION 7 269

Maging Matalino sa Pangangalaga ng Iyong Puso: Kontrolin ang mga ABC ng Diyabetis

(continued)

• Ang C ay para sa kolesterol. Panatilihin ang isang normal na antas ng kolesterol. Ang

“masamang” kolesterol, o LDL, ay namumuo at binabarahan ang iyong mga ugat. Kunin ang iyong kolesterol nang hindi bababa sa isa sa isang taon.

Bilang na dapat hangarin: mas mababa sa 100 mg/dL

Petsa

Resulta

Tiyakin na tanungin ang iyong duktor:

• Ano ang mga numero ng aking ABC?
• Ano ang dapat na mga puntiryang numero ng aking ABC?
• Anong mga pagkilos and dapat kong gawin upang maabot ang mga puntiryang numero ng

aking ABC?

Isulat ang mga pagbabago na gagawin mo para sa linggong ito upang makontrol ang iyong asukal sa dugo, presyon ng dugo, o kolesterol.

(Petsa)

(Petsa)

270 HANDOuT—SeSSION 7

Read the Nutrition Facts Label for Sugar!

Nutrition Facts labels tell you what you need to know about choosing foods that are lower in calories and sugar. Here is a Nutrition Facts label for mango nectar. The label provides lots of useful information.

Mango Nectar

Nutrition Facts

Serving Size 1 Servings Per Container 1

Amount Per Serving

Amount Per Serving

The nutrient amounts

Serving Size and Number of Servings The serving size is 1 cup. There is one serving in this container.

Calories from Fat 0

provided on the label are for one serving. If you have

% Daily Value*

more than one serving, you will get more calories and other nutrients. For example, if you drink two servings (2 cups) of mango nectar, you

Total Fat 0g Saturated Fat 0g Trans Fat 0g Cholesterol 0mg Sodium 15mg

Total Carbohydrate 56g

will take in 460 calories and

Dietary Fiber 2g

100 grams of sugar.

Sugars 50g

Calories and Sugar Protein 0g Here are the amounts of calories

0% 0%

Percent Daily Value 0% The Percent Daily Value 1% helps you compare nutrient 19% amounts in products. There 8% is no Percent Daily Value for calories or sugar. Choose foods with the lowest amount of calories and sugar.

Vitamin C 100%

and sugar in one serving.

Calcium 4% • Iron 4%

The Choice Is Yours— Calories 230 Calories from Fat 0 Compare! % Daily Value*

Total Fat 0g 0%

Which one would you Saturated Fat 0g 0%

Trans Fat 0g

choose?

Cholesterol 0mg 0% Sodium 15mg 1%

The unsweetened iced tea has Sugars 50g fewer calories and no sugar.

Calories 5 Calories from Fat 0

That makes the iced tea a better choice! Read Nutrition Facts % Daily Value* labels, and choose products to Total Fat 0g 0%

Saturated Fat 0g 0%

keep your heart strong.

Trans Fat 0g Cholesterol 0mg 0% Sodium 0mg 0% Sugar 0g

Mango Nectar One cup of mango nectar has 230 calories and 50 grams of sugar.

Unsweetened Iced Tea One cup of unsweetened iced tea has 5 calories and no sugar. You can learn a lot from a Nutrition Facts label.

are based on a 2,000-calorie diet. Your Daily Values may be higher or lower depending on your calorie needs.

HANDOuT—SeSSION 7

Basahin ang Label ng Mga Katotohanan sa Nutrisyon para sa Asukal!

Ang mga

label ng Mga Katotohanan sa Nutrisyon ay nagsasabi sa iyo kung ano ang kinakailangan mong malaman tungkol sa pagpili ng mga pagkain na mababa sa mga calorie at asukal. Narito ang isang ng Mga Katotohanan sa Nutrisyon para sa nagbibigay ng mga kapakipakinabang na impormasyon.

Dami sa bawat Takal Ang dami ng nutrisyon ay ipinakita sa label na para sa isang takal. Kung mayroon kang higit sa isang takal, ikaw ay makakakuha ng mas maraming mga calorie at ibang mga nutrisyon. Halimbawa, kung iinom ka ng dalawang takal (2 tasa) ng mango nectar, makakakuha ka ng 230 na calorie at 50 na gramo ng asukal.

Mga Calorie at Asukal Narito ang mga dami ng mga calorie at asukal sa isang takal.

Mango nectar

Nutrition Facts Laki ng Takal at Bilang

Serving Size 1 ng Mga Takal

Servings Per Container 1

Ang laki ng takal ay Amount Per Serving 1 tasa. Mayroon itong Calories 230 Calories from Fat 0 walong mga takal sa lalagyan na ito.

% Daily Value*

Total Fat 0g 0%

Porsyento ng Pang-

Saturated Fat 0g 0%

araw-araw na Halaga

Trans Fat 0g

Cholesterol 0mg 0% Ang Porsyento ng Pang- Sodium 15mg 1% araw-araw na Halaga Total Carbohydrate 56g 19% ay nakakatulong sa iyo

Dietary Fiber 2g 8%

sa paghambing ng mga

Sugars 50g

dami ng nutrisyon sa

Protein 0g

mga produkto. Walang Vitamin A 35% • Vitamin C 100% Porsyento ng Pang-araw-

Calcium 4% Iron 4%

• araw na Halaga para sa mga calorie o asukal. Pumili ng mga pagkain na mababa ang dami ng mga calorie at asukal.

HANDOuT—SeSSION 7

Basahin ang

Label ng Mga Katotohanan sa Nutrisyon para sa Asukal!

Ikaw ang Bahalang Mamili—Ihambing!

Ano ang iyong pipiliin?

ay kaunti ang mga calorie at walang asukal. Na gagawing mas iced tea! Nutrisyon at pumili ng mga produkto upang mapanatili na malakas ang iyong puso.

Mango nectar Isang tasa ng mango nectar ay mayroong 230 na mga calorie at 50 na mga gramo ng asukal.

Calories 150 Calories from Fat 0

% Daily Value* Total Fat 0g 0% Saturated Fat 0g 0% Trans Fat 0g

Sugars 32g

Unsweetened Iced Tea Isang tasa ng unsweetened iced tea ay mayroong 5 na mga calorie at walang asukal. Maaaring marami kang matutunan mula sa isang label ng Mga Katotohanan sa Nutrisyon.

Calories 5 Calories from Fat 0

% Daily Value* Total Fat 0g 0% Saturated Fat 0g 0% Trans Fat 0g

Dietary Fiber 0g Sugars 0g

HANDOuT—SeSSION 7 273

Mila’s Food Choices

1 – Pan de Sal (Filipino Roll)

Mila has offered

to go grocery Nutrition Facts

Serving Size 1 roll (25g)

shopping for her

Servings Per Container 16

mother, Lola

Amount Per Serving

Idad, who is home sick with Calories140 Calories from Fat 14 the flu. Lola also

% Daily Value*

has diabetes. Lower

Total Fat 1.5g 2% sugar Saturated Fat 0g 0% choice

Mila wants to

Trans Fat 0g ______

buy foods that

Cholesterol 0mg 0%

are lower in Sodium 330mg 14%

Grams

calories and Total Carbohydrate 38g 13%

of sugar Dietary Fiber 2g 4%

sugar to help her saved

Sugars 1g

mother. Look ______

Protein 6g

at the Nutrition Facts labels. Vitamin A 10% • Vitamin C 0% Help Mila select Calcium 6% • Iron 10% foods that are lower in sugar.

3 – Cooked Oatmeal

Which foods

should Mila buy? Nutrition Facts

Serving Size ½ cup

Write the number

Servings Per Container 13

of your choice

Amount Per Serving

for each pair. Then write the Calories130 Calories from Fat 20 number of grams

% Daily Value*

of sugar saved by Lower

Total Fat 2g 3%

this choice. sugar

Saturated Fat 0g 0% choice Trans Fat 0g ___ Cholesterol 0mg 0% Sodium 0mg 0% Grams Total Carbohydrate 22g 7% of sugar Dietary Fiber 4g 16% saved Sugars 0g Protein 5g ______

Vitamin A 0% • Vitamin C 0% Calcium 13% • Iron 10%

2 – Doughnut

Nutrition Facts

Serving Size 1 doughnut (54g) Servings Per Container 5

Amount Per Serving

Calories 290 Calories from Fat 170

% Daily Value*

Total Fat 19g 29% Saturated Fat 6g 30% Trans Fat 2g

Sugars 15g Protein 3g

Vitamin A 0% • Vitamin C 0% Calcium 2% • Iron 8%

4 – Bibingka (Sweet Rice Cake)

Nutrition Facts

Serving Size 1 popsicle (273g) Servings Per Container 4

Amount Per Serving

Calories 890 Calories from Fat 460

% Daily Value*

Total Fat 51g 78% Saturated Fat 37g 185% Trans Fat 0g

Sugars 44g Protein 15g

Vitamin A 17% • Vitamin C 3% Calcium 105% • Iron 21%

• Percent Daily Values are based on a 2,000-calorie diet. Your Daily Values may be higher or lower depending on your calorie needs.

274 HANDOuT—SeSSION

Mila’s Food Choices

5 – Gelatin

Nutrition Facts

Serving Size ¼ cup Servings Per Container 8

Amount Per Serving

Calories 80 Calories from Fat 0

% Daily Value*

Total Fat 0g 0% Saturated Fat 0g 0% Trans Fat 0g

Sugars 19g Protein 2g

Vitamin A 0% • Vitamin C 0% Calcium 0% • Iron 0%

7 – Fat-Free, No-Sugar-Added Ice Cream

Nutrition Facts

Serving Size ½ cup (66g) Servings Per Container 16

Amount Per Serving

Calories 80 Calories from Fat 0

% Daily Value*

Total Fat 0g 0% Saturated Fat 0g 0% Trans Fat 0g

Sugars 4g Protein 3g

Vitamin A 6% • Vitamin C 0% Calcium 8% • Iron 0%

6 – Sugar-Free Gelatin

Nutrition Facts

Serving Size ¼ cup Servings Per Container 8

Amount Per Serving

Calories 10 Calories from Fat 0

% Daily Value*

Lower Total Fat 0g 0% sugar Saturated Fat 0g 0% choice Trans Fat 0g ______ Cholesterol 0mg 0% Sodium 55mg 2% Grams Total Carbohydrate 0g 0% of sugar Dietary Fiber 0g 0% saved Sugars 0g Protein 1g ___

Vitamin A 0% • Vitamin C 0% Calcium 0% • Iron 0%

8 – Chocolate Ice Cream

Nutrition Facts

Serving Size ½ cup (66g) Servings Per Container 16

Amount Per Serving

Calories 170 Calories from Fat 80

% Daily Value*

Lower Total Fat 9g 14% sugar Saturated Fat 6g 30% choice Trans Fat 0g ___ Cholesterol 20mg 7% Sodium 40mg 2% Grams Total Carbohydrate 21g 7% of sugar Dietary Fiber 1g 4% saved Sugars 17g ______ Protein 2g

Vitamin A 4% • Vitamin C 0% Calcium 6% • Iron 4%

are based on a 2,000-calorie diet. Your Daily Values may be higher or lower depending on your calorie needs.

HANDO

Mila’s Food Choices

9 – Water

Nutrition Facts

Serving Size 1 bottle (16 oz) Servings Per Container 1

Amount Per Serving

Calories 0 Calories from Fat 0

% Daily Value*

Total Fat 0g 0% Saturated Fat 0g 0% Trans Fat 0g

Sugars 0g Protein 0g

Vitamin A 0% • Vitamin C 0% Calcium 0% • Iron 0%

10 – Regular Soda

Nutrition Facts

Serving Size 1 can (12 fl oz) Servings Per Container 1

Amount Per Serving

Calories 140 Calories from Fat 0

% Daily Value*

Lower Total Fat 0g 0% sugar Saturated Fat 0g 0% choice Trans Fat 0g ______ Cholesterol 0mg 0% Sodium 50mg 2% Grams Total Carbohydrate 39g 13% of sugar Dietary Fiber 0g 0% saved Sugars 39g Protein 1g ___

Vitamin A 0% • Vitamin C 0% Calcium 0% • Iron 0%

are based on a 2,000-calorie diet. Your Daily Values may be higher or lower depending on your calorie needs.

HANDO

Think Before You Drink: Hidden Sugar in Common Beverages

Try to guess the amount of sugar (in teaspoons) that is found in each drink.

Drink (12 ounces)

Powdered drink with sugar

Diet soda

Grape juice

Regular soda

Mango nectar

Energy Drink (8 ounces)

Write your answers on the “My Guess” line.

Teaspoons of Sugar

My Guess

______

______

______

______

______

______

True Amount

______

______

______

______

______

______

HANDOuT—SeSSION 7 277

How Much Sugar and How Many Calories Are in Your Favorite Drink?

Approximate Number of Teaspoons of Sugar*

Energy Drink (8 ounces) 25 grams 6¼ teaspoons

Chocolate Drink (6.5 ounces) 22 grams 5½ teaspoons

• 1 teaspoon = 4 grams of sugar

278 HANDOuT—SeSSION 7

(Fish Simmered With Ginger and Tomatoes) Recipe

4 cups water 1. 1 cup ripe tomatoes, chopped ¼ cup fresh ginger, thinly sliced (about 2 inches long) 1 cup white or yellow onions, 2. thinly sliced (1 medium onion) 2 pounds fleshy fish (cod fillet, halibut steak, or trout) 3.

2 cups pechay (bok choy) stems and leaves, cut up separately ½ teaspoon salt 4. ½ teaspoon ground pepper 1 cup (about green onions, cut 2 to 3 1 large inches (6 medium) bunch)

Quick Facts

This main dish is heart healthy because:

1. It is made with fish and vegetables.
2. The fish is simmered in water, not fried.
3. No fat is added to the dish.
4. Flavoring is added with herbs and spices instead of sauces that are high in sodium.

In a 4-quart saucepan, simmer sliced ginger, tomatoes, and onions in 4 cups of water over medium heat until onions are tender (about 7 to 8 minutes).

Reduce heat to low, add fish, and poach gently until almost done (about 3 to 4 minutes).

Add pechay stems, salt, and ground pepper. Cook for 1 minute; then add pechay leaves and green onions. Cook another 30 seconds.

Serve immediately.

Serving size: 3 ounces lean Yield: fish and ½ cup 6 servings vegetables: Calories 160 kcal Total Fat 2 g Saturated Fat 0.5 g Cholesterol 80 mg Sodium 340 mg Total Fiber 2 g Protein 30 g Carbohydrates 6 g Potassium 630 mg

Source: Filipino American Food Practices, Customs, and Holidays, American Dietetic Association, 1994.

HANDOuT—SeSSION

7 279

Munggo Guisado (Sauteed Mung Beans) Recipe

1 tablespoon corn oil 1. 2 cloves fresh garlic, crushed (or 1 tablespoon, minced) 2. 1 cup white onions, chopped (1 medium) 3. 1 cup raw tomatoes, chopped (2 small) 4. 1 cup raw lean pork, thinly sliced (4 ounces) 1 cup raw shrimp, peeled 5. (4 ounces) 1 cup leaf spinach, frozen (about 6. /3 of a 10-ounce package) 7. 3½ cups precooked mung beans (from 1¾ cups dry 8. beans)*

4 cups 1 teaspoon 1 teaspoon

water salt ground pepper

• To cook dry, uncooked mung beans: Wash and boil the uncooked mung beans in a large saucepan, using 6 cups of water. Cook until tender, about 1½ to 2 hours. Drain.

Quick Facts

This side dish is heart healthy because:

1. It is made with vegetables, seafood (shrimp), and lean meat.
2. A small amount of corn oil is added.
3. The pork is simmered slowly in

In a skillet, heat oil, and saute crushed garlic until lightly brown.

Add onion and tomatoes. Saute until skin begins to curl.

Add pork, and saute until lightly brown.

Add water, and simmer pork for about 15 minutes.

Add the sauteed mix to mung beans, and continue to simmer 15 minutes.

Season with salt and ground pepper.

Add peeled shrimp.

Add frozen leaf spinach, and cook 4 minutes until done.

Yield: Serving size: 8 servings 1 cup: Calories 160 kcal Total Fat 3.5 g Saturated Fat 1 g Cholesterol 35 mg Sodium 350 mg Total Fiber 8 g Protein 13 g Carbohydrates 19 g Potassium 370 mg

Filipino American Food Practices, Customs, and Holidays,

moist heat.

American Dietetic Association, 1994.

SSION

Lola’s Life Lessons: Session 7

One of my favorite proverbs is:

“Sa taong walang takot, walang mataas na bakod.”

Translation: “To a fearless person, no fence is too high.”

With courage, there is hope. Although Rose has prediabetes, she can do something to decrease her chance of getting diabetes: lose weight, become physically active, and eat heart healthy. She is lucky—still young and strong! Your Lolo (grandfather) had diabetes, and controlling his blood glucose was not a priority for him. He had a chance to be fearless, but he loved food too much.

It takes a courageous person to admit what is not working and try to change it. I know how hard it can be to change old habits. But look at Lola. I am an “old timer,” and I was fearless. I did not give up! You must be fearless to tackle things that are high priority, even if it seems impossible. With each day, my family is learning that hope will not fail you. Remember, no fence is too high!

A Time To Reflect…

What changes have you made in your life to become heart healthy? What new changes can you make to continue on the journey to heart health?

(Use this space to write down your thoughts for this week’s session.)

HANDOuT—SeSSION 7 281

Pledge for Life! Session 7

Take the pledge for life with Lola Idad’s family. Try to do one or more of these activities by yourself or share them with others.

Know the symptoms of diabetes.

Talk to your doctor about your risk factors for diabetes and about your ABC numbers.

Find out if you or other family members have prediabetes or diabetes.

Eat smaller portions of food.

Do physical activity every day.

Lose weight if you are overweight or obese.

Maintain your weight if it is in the healthy range.

Keep a food and physical activity diary.

Make reasonable goals for yourself and reward yourself with non-food items, like watching a movie.

Other

282 HANDOuT—SeSSION 7

s essi o n

Welcome Heart Healthy Eating Into Your Home

Objectives

By the end of this session, group members will learn:

• How to plan and prepare traditional Filipino meals in a heart healthy way
• How to choose foods for a heart healthy eating plan

Materials and Supplies

To conduct this session, you will need:

• “Healthy Heart, Healthy Family” manual and picture cards
• Set of measuring cups (1 cup, ½ cup, ¼ cup)
• Blackboard and chalk or several large pieces of paper, a marker, and tape
• Enough pairs of scissors and glue sticks for group members to use during the activity

Handouts

Give group members these handouts during this session:

• (Optional) “Serving Sizes” (from Session 6, page 224)
• “Heart Healthy Eating Plan” (pages 307–309)

Session 8. Welcome Heart Healthy Eating Into Your Home 283

• “Add Color and Flavor to Your Menu” (pages 310–313)
• “Say Yes to Fruits and Vegetables” (pages 314–315)
• (Optional) “Heart Healthy Scenarios With the de la Cruz Family” (pages 316– 318)
• “Ampalaya (Bitter Melon) With Pork Recipe” (page 319)
• “Cooking With Children” (pages 320–321)
• “Cantaloupe Crush Recipe for Children” (page 322)
• “Lola’s Life Lessons: Session 8” (page 323)
• “Pledge for Life! Session 8” (page 324)

Session Outline

Introducing the Session

1. Welcome
2. Review of Last Week’s Session
3. About This Session

Conducting the Session

1. Eat a Variety of Heart Healthy Foods
2. The Traditional Filipino Diet
3. A Heart Healthy Eating Plan for Filipino Families
4. How To Choose Heart Healthy Foods

284 Healthy Heart, Healthy Family: A Community Health Worker’s Manual for the Filipino Community

1. (Optional) Heart Healthy Scenarios With the de la Cruz Family
2. Ampalaya (Bitter Melon) With Pork Recipe
3. Cooking With Children

Review of Today’s Key Points

Lola’s Life Lessons: A Time To Reflect

Pledge for Life!

Closing

Introducing the Session

1. Welcome

• Welcome group members to the session.

2. Review of Last Week’s Session

At the last session, we talked about what you need to know about diabetes.

• Ask these questions, and review the answers with group members.

What is diabetes?

• Diabetes results when the body does not make enough insulin or cannot make

it well, causing glucose (sugar) to build up in the blood. As a result, the body does not function well.

Session 8. Welcome Heart Healthy Eating Into Your Home 285

What are risk factors for diabetes?

• Overweight

• Family members with diabetes

• Not having a physically active lifestyle

• Being Latino, African American, American Indian, Asian American, or Native

Hawaiian or other Pacific Islander

• History of gestational diabetes or having given birth to at least one baby

weighing 9 pounds (4.1 kg) or more

• High blood pressure

• Cholesterol levels are not normal: HDL cholesterol is low, or triglycerides

are high

What are the ABCs of diabetes control?

• A is for the A1C test. This simple lab test reflects a person’s average blood

glucose level over the previous 3 months. The A1C number to aim for is below seven.

• B is for blood pressure. The higher your blood pressure, the harder your

heart has to work. High blood pressure increases your risk for a heart attack, stroke, and damage to your kidneys and eyes. Your blood pressure should be below 130/80 mmHg (millimeters of mercury).

• C is for cholesterol. Keep cholesterol at normal levels. Bad cholesterol, or

LDL, can build up and clog your arteries. It can lead to a heart attack or stroke. People with type 2 diabetes need to keep their LDL cholesterol below 100 mg/dL (milligrams per deciliter).

How does diabetes affect your body?

• Diabetes can cause damage to the heart, brain, kidneys, and eyes. It can

cause nerve damage, which reduces feeling in your feet. Diabetes can also affect blood flow in your legs and feet. This can lead to sores that don’t heal and amputation.

286 Healthy Heart, Healthy Family: A Community Health Worker’s Manual for the Filipino Community

At the end of the last session, you made a pledge to do something to help you prevent or control diabetes. What problems did you have? How did you deal with any problems?

Note: Allow 2 minutes for each group member to respond.

3. About This Session

In this session, you will learn that what you choose to eat can make a difference in your heart health. With the help of Lola’s family, you will learn how to:

• Choose a variety of foods for heart health.

• Identify serving sizes and the number of recommended servings for each

food group.

• Lola Idad encourages her family to make these heart healthy

changes together. She often says, “Ang mabigat ay gumagaan, kung pinagtutulungan.” “A heavy burden is lightened if everyone participates in carrying it.”

• The de la Cruz family members support one another as they learn how to

welcome heart healthy eating into their home.

Conducting the Session

1. Eat a Variety of Heart Healthy Foods

• Ask:

Why is it important to eat a variety of heart healthy foods?

Session 8. Welcome Heart Healthy Eating Into Your Home 287

Note: Allow about 5 minutes for group members to respond. Write their answers on the blackboard or on a large piece of paper taped to the wall.

• Add the answers below if group members More Information do not say them. Nutrients in the

• Eating a variety of foods that are

foods we eat include: lower in saturated fat, trans fat,

cholesterol, salt and sodium, added sugar, and calories can help you have a healthy heart.

Carbohydrates Protein Fats Fiber

• One food cannot provide all the Vitamins

nutrients your body needs in the Minerals amounts that it needs them.

2. The Traditional Filipino Diet

Note: This session will help group members think about the foods they eat. Some of their favorite traditional Filipino foods are very nutritious. Other dishes can be prepared in more heart healthy ways.

• Ask:

What are some traditional Filipino foods?

Note: Allow about 5 minutes for group members to respond. Write their answers on the blackboard or on a large piece of paper taped to the wall.

Many traditional Filipino foods are heart healthy for you and your family. These include:

• Steamed rice, white or brown

• Beans, such as mung beans, black beans, and string beans

• Fruits, such as mango

288 Healthy Heart, Healthy Family: A Community Health Worker’s Manual for the Filipino Community

• Vegetables, such as squash and carrots

• Fish and seafood, such as milkfish (bangus), grouper (lapu-lapu), shrimp

(hipon), mackerel (galunggong), mussels (tahong), clams (tulya), large and small crabs (alimango and alimasag), and squid (pusit)

Rice is a very important part of the Filipino diet. Rice and fish, together, are a good source of protein. But we need to be careful about the way we prepare them.

Some Filipinos have adopted cooking and eating habits that can lead to health problems such as heart disease. What are some examples of these habits?

Note: Allow about 3 minutes for group members to answer. Add these habits if they are not mentioned:

• Cooking foods with too much saturated fat, such as lard and shortening, as

well as coconut oil and palm oil

• Eating fried foods often, such as longanisa (native sausage), fried lumpia

(egg roll), sinangag (garlic fried rice), and fried meat and vegetables

• Eating foods higher in saturated fat, such as fatty meats, canned and

processed meat, high-fat cheeses and creams, whole milk, banana chips, and other chips

• Eating foods that are higher in calories, such as bibingka or ginataan

(desserts that contain coconut milk), candies, and chocolate

• Drinking high-calorie beverages such as regular soft drinks

• Eating fewer fruits and vegetables

• Eating meats high in saturated fat instead of lean meats

Session 8. Welcome Heart Healthy Eating Into Your Home 289

• Eating foods high in trans fat such as cookies, crackers, doughnuts, baked

goods, and french fries

• Eating sauces high in sodium, such as soy sauce, bagoong (salted fish paste)

and patis (fish sauce).

3. A Heart Healthy Eating Plan for Filipino Families

We can take steps to improve the way we eat and still enjoy our traditional foods. The first step is to learn which foods we should eat more often. The second step is to learn the amounts of these foods that we should eat each day.

• Show picture card 8.1. (Keep it in view throughout this activity.)

This heart healthy eating plan shows us the types of foods we can choose for better health.

• Give group members the “Heart Healthy Eating Plan” handout (pages 307–309).

The food choices you make each day affect your health. We will talk about ways to choose healthy foods from the food groups in the heart healthy eating plan.

Grains (6 to 8 servings a day)

• Make at least half of your grains whole grains. Eat at least three servings of

whole-grain cereals, breads, rice, or noodles (pasta) every day. Remember, one ounce of grains is a serving. In general, 1 ounce of grains is one slice of bread, about 1 cup of ready-to-eat cereal, or ½ cup of steamed rice, cooked noodles, or cooked cereal.

290 Healthy Heart, Healthy Family: A Community Health Worker’s Manual for the Filipino Community

• Look at the Nutrition Facts label, and choose grain products that have whole

grains as the first ingredient. Some examples of whole-grain ingredients are whole wheat, whole oats, oatmeal, and whole rye.

• For a change, try brown rice or whole-wheat noodles instead of white rice

or noodles.

• Snack on ready-to-eat, whole-grain cereal such as toasted oat cereal. Also try

popcorn with little or no salt or butter as a snack.

Vegetables (4 to 5 servings a day)

• Eat more dark green vegetables, such as bok choy (pechay), broccoli,

spinach, and other dark leafy greens.

• Eat more orange vegetables, such as carrots and sweet potatoes (camote).

• Stock up on frozen vegetables for quick and easy cooking in the microwave.

• Buy fresh vegetables in season. They cost less and are likely to be at their

peak flavor.

• Plan some meals around a vegetable main dish, such as vegetable stirfry

or soup.

• Choose no-salt-added canned vegetables.

Fruits (4 to 5 servings a day)

• Choose fresh, frozen, canned, or dried fruit.

• Limit fruit juices, because they contain a lot of calories and sugar. Try

choosing whole fruit instead of juice most of the time.

• Keep a bowl of whole fruit on the table, on the counter, or in the refrigerator.

Session 8. Welcome Heart Healthy Eating Into Your Home 291

Fat-free or low-fat milk and milk products (2 to 3 servings a day)

• Get your calcium-rich foods.

• Choose fat-free or low-fat milk, yogurt, and other milk products.

• If you usually use whole milk, switch gradually to fat-free milk. Try

reduced-fat (2%) milk, then low-fat (1%) milk, and then fat-free milk.

• Have fat-free or low-fat yogurt for a snack.

• If you are lactose intolerant, try lactose-free products, such as yogurt, cheese,

or lactose-free milk.

Lean meats, poultry, and fish (2 or fewer 3-ounce servings a day)

• Choose low-fat or lean meats and poultry. Select meat cuts that are low in fat

and ground beef that is extra lean.

• Eat a variety of foods with protein. Choose more fish, seafood, and tofu.

• Choose lean chicken, roast beef, or ham, instead of fatty lunch meats, such as

regular bologna or salami.

• Bake, steam, broil, or grill meat.

Nuts, seeds, and legumes (4 to 5 servings a week)

• Choose cooked and dry beans, nuts, seeds, and peas for rich sources of

protein and fiber.

292 Healthy Heart, Healthy Family: A Community Health Worker’s Manual for the Filipino Community

Fats and oils

• Get most of your fat from food sources, such as fish and seafood, nuts, and

vegetable oils.

• Limit solid fats and oils such as butter, stick margarine, shortening, lard,

coconut oil, and palm oil, as well as foods that contain these fats.

Sweets and added sugars (5 or fewer servings a week)

• Choose foods and beverages that are low in calories and added sugar. Use

the Nutrition Facts label to compare the calorie and sugar content of foods and beverages.

• Choose water, fat-free milk, or other unsweetened beverages most often.

• Select unsweetened cereal and add a noncalorie sweetener or fruit.

• Ask these questions, and hold up the correct measuring cup for each answer.

What is one serving of a cooked vegetable?

• ½ cup

How much milk or yogurt is considered one serving?

• 1 cup

How much cheese is considered one serving?

• 1.5 to 2 ounces

Can you give an example of a 1-ounce serving from the grains group?

• 1-ounce servings from the grains group include:

• ½ cup of steamed rice or noodles
• One slice of bread
• About 1 cup of ready-to-eat cereal or ½ cup of cooked cereal, such as oatmeal

Session 8. Welcome Heart Healthy Eating Into Your Home 293

What counts as one serving of fruit?

• 1 medium apple, banana, or orange

• ½ cup of raw or canned fruit or 100% fruit juice

• ¼ cup dried fruit

Say Yes to Fruits and Vegetables Activity

• Divide participants into small groups of three to four people.
• Give every small group the “Add Color and Flavor to Your Menu” handout (pages 310–313) and the “Say Yes to Fruits and Vegetables” handout (pages 314–315).
• Give each group a pair of scissors and a glue stick, so they can cut out and paste the pictures.

Now let’s do the “Say Yes to Fruits and Vegetables” activity to learn how to add fruits and vegetables to your meals.

For this activity, cut out the pictures of fruits and vegetables on the handout that I gave you. Cut out the fruits and vegetables that you want to add to your breakfast, lunch, dinner, and snack. Then paste your fruit and vegetable choices in the correct spaces on each menu.

Note: Allow 10 minutes for group members to complete their meals.

• Ask each group member to say what fruits and vegetables they added to their meals.
• Then, ask the rest of the group members if they have any other suggestions.

294 Healthy Heart, Healthy Family: A Community Health Worker’s Manual for the Filipino Community

Great job! Now you know how easy and fun it can be to add fruits and vegetables to your meals.

How To Choose Heart Healthy Foods

We are going to do another group activity. During this activity, we will learn how to make better food choices.

Write Rose’s breakfast on the blackboard or on a large piece of paper taped to the columns. Leave the Repeat the game with the lunch and dinner meals.

BREAkFAST

Rose’s Food Group Portion Breakfast (Leave blank for activity) Size

Fried egg Meats and beans 1 egg

Bacon Meats and beans 3 strips

Fried rice (with egg, Grains, meats and beans, ½ cup green onions, garlic, vegetables, fats and oils butter, sausage)

Mango nectar drink Fruit ½ cup

Coffee with condensed Milk 1 cup coffee milk 1 tablespoon of milk

Better Choices

(Leave blank for activity)

Boiled or poached egg, ½ cup egg substitute, or 2 egg whites. Scramble egg with vegetable oil spray.

Leftover grilled chicken, 3 ounces; or Canadian bacon, 2 strips

Plain, steamed white or brown rice, ½ cup

Pineapple juice or fresh mango, ½ cup

Coffee with fat-free milk (or 1 tablespoon of evaporated fat-free milk)

Session 8. Welcome Heart Healthy Eating Into Your Home

• Ask:

To which group does each food belong? What changes would make Rose’s breakfast more heart healthy?

• Write the suggestions beside the foods they are replacing on the blackboard or on a large piece of paper taped to the wall. Fill in the correct answers for any items not mentioned by group members.
• (Optional meals: lunch and dinner)

LuNCH

Rose’s Food Group Portion Better Choices Lunch (Leave blank for activity) Size (leave blank for activity)

Large bacon Meats and beans, grains, 1 large Leftover shrimp; steamed cheeseburger with milk, vegetables, fats cheeseburger vegetables, ½ cup mayonnaise and oils

Super-size french fries Vegetables, fats and oils 1 large Steamed white or brown (6 ounces) rice, ½ cup serving of fries

Apple pie Fruits, grains, fats and 1 large Fresh papaya, ½ slice oils, sweets and added (2.7 ounce) sugars serving

Vanilla milkshake Milk, sweets and added 1 milkshake, Fat-free or low-fat milk, or sugars 32 ounces lactose-free milk

296 Healthy Heart, Healthy Family: A Community Health Worker’s Manual for the Filipino Community

DINNER

Rose’s Food Group Portion Dinner (Leave blank for activity) Size

Fried lumpia Meats and beans, fats 3 fried lumpia and oils

Fried chicken with Meats and beans, grains, 2 pieces of fried rice fats and oils chicken, 1½ cups fried rice

Large soft drink Sweets and added 1 cup sugars

Flan Fats and oils, milk, 1 slice sweets and added sugars, meat and beans

• Ask:

Better Choices

(leave blank for activity)

Fresh lumpia (1)

Pancit with shrimp and lean pork (1 ounce cooked)

Water, diet soft drink, soy milk (1 cup), or fruit juice (½ cup)

Fresh fruit cup (½ cup) or low-fat frozen yogurt

fat, cholesterol, sodium, and calories?

• Add the following answers if they are not mentioned:

• When shopping:

Choose a variety of whole grains, fruits, and vegetables.

Choose low-fat or fat-free milk products, salad dressings, and mayonnaise.

• Choose lean cuts of meat. Trim away extra fat.

Read Nutrition Facts labels to choose foods lower in saturated fat, fat, cholesterol, sodium, sugar, and calories.

Session 8. Welcome Heart Healthy Eating Into Your Home

• When cooking:

• Use vegetable oil or soft tub margarine instead of butter, lard, or coconut oil.
• Cook using low-fat methods, such as baking, steaming, broiling, or grilling (without added fat), rather than frying.

• When eating:

• Eat foods that are low in saturated fat, trans fat, and added sugars.
• Remove skin from poultry. Throw away the skin, and do not eat it.
• Choose low-fat or fat-free milk products, salad dressings, and mayonnaise.
• Eat no more than four egg yolks each week.
• Eat fewer high-calorie foods with little added nutritional value, such as high-fat lunch meats, pies, cakes, cookies, crackers, and chips. Drink fewer sodas.
• Eat smaller portion sizes.

There are creative ways to make healthier versions of Filipino foods that are traditionally high in fat and sodium. Experiment with your favorite recipes! For example, try using evaporated low-fat milk instead of cream when making leche flan.

Thank you for participating in this activity! You did great! Now you can make healthier choices for yourself and your family.

298 Healthy Heart, Healthy Family: A Community Health Worker’s Manual for the Filipino Community

5. (Optional) Heart Healthy Scenarios With the de la Cruz Family: Group Activity

Note: This activity will help group members think about ways they can help their relatives and friends make healthier food choices. You may select one or more scenarios to review.

• Give group members the “Heart Healthy Scenarios With the de la Cruz Family” handout (pages 316–318).
• Divide group members into groups of three to five people, and give each group a different scenario (handout) to discuss.

Each group will read the scenario on the handout and think about ways to solve the problems described. Please choose one member of your group to read the story and questions aloud to the group. Write down the group’s solutions to each of the questions.

• Note: Allow 5 to 7 minutes for group members to complete the activity.

I would like one volunteer from each group to read the story and the answers to the questions aloud.

Note: After each volunteer reads the story and solutions, ask the entire group to share any other solutions.

Heart Healthy Scenarios With the de la Cruz Family

Scene 1: Helena’s Fast Food Dilemma

Mila’s friend Helena is a busy, working mom with two children. She rarely makes dinner for her family because of her busy schedule. Helena takes her children to fast food restaurants three or four times a week. Her sons love eating hamburgers and french fries, drinking soda, and getting free toys. But she wants her children to live healthy lives. She is worried that they are spending too much time playing video games and watching television after school and meals. Combined with the fast food, Helena is worried that her sons will become overweight soon.

Session 8. Welcome Heart Healthy Eating Into Your Home 299

Note: Add the following answers to each question if they are not mentioned.

• What can Helena do on her busy schedule to feed her children healthy meals?

• Helena could make meals in a slow cooker (Crock-Pot®) so they can cook

during the day and be ready when she and her sons get home.

• She could buy roasted chicken instead of hamburgers and fries at fast

food restaurants.

• She could buy steamed fish or vegetable dishes from a Chinese

carryout restaurant.

• What else can Helena do to help her children live healthy lives?

• She could limit the time her children spend playing video games and

watching television.

• She could turn off Saturday morning cartoons and take her sons to a park or

bike with them to the library instead.

• She could encourage her children to play active outdoor games instead of

video games.

• When she does allow her children to watch TV, she could have them practice

tai chi or play with a hula hoop at the same time.

Scene 2: Cesar’s and Mila’s Parties

Cesar and Mila like to have parties at their house. They enjoy the company of their family and friends. They usually celebrate with a lot of food and drink. They love to make chicken, leaving the skin on, fried lumpia with pork, sinangag (garlic fried rice) with a lot of patis (fish sauce), and sweet desserts. Their gatherings start in the afternoon and usually last through the evening. Most of the time, they are sitting down eating and drinking alcohol. At least once a week, Cesar and Mila’s friends take turns hosting parties at their houses.

Note: Add the following answers to each question if they are not mentioned.

300 Healthy Heart, Healthy Family: A Community Health Worker’s Manual for the Filipino Community

• What can Cesar and Mila make for their own parties or bring to friends’ parties to make them more heart healthy?

• Water, unsweetened tea, and diet soft drinks

• Dishes of steamed fish or seafood, noodles or steamed rice, and vegetables

• Fresh lumpia

• Platters of sliced fresh fruit such as papaya, cantaloupe, pineapple,

and mango.

• Lower-fat desserts such as puto and mamon.

• How can Cesar and Mila stick to their healthier eating plan when they are at the parties?

• Eat smaller portions.

• Do not take second helpings of high-calorie foods. Eat fresh fruit if you are

still hungry.

• Eat less food that is high in fat, such as fried foods.

• Eat fewer foods that are high in sodium, such as chips and sauces.

• Eat fewer foods that are high in fat and added sugar, such as desserts made

with coconut milk, pastries, cookies, and chocolate.

• What else can Cesar and Mila do?

• Eat a healthy snack before the party so they are not hungry.

• Take a walk after eating.

• Limit their alcohol to one drink for Mila and two drinks for Cesar.

Session 8. Welcome Heart Healthy Eating Into Your Home 301

(Optional) Scene 3: Eating When Stressed or Bored

Jose is trying to stay heart healthy. His doctor says he needs to lower his blood pressure and lose some weight. But eating makes him feel better when he is stressed or bored. He says it takes his mind off his problems. Even when he is not hungry, Jose likes to snack on pork rinds, salted peanuts, and regular sodas while watching television.

Note: Add the following answers to each question if they are not mentioned.

• How can Jose eat better to lose weight and lower his blood pressure?

• Jose could make it a practice to eat only when he feels hungry.

• He could eat fresh fruit or fat-free yogurt.

• He could eat fewer foods and sauces that are high in sodium.

• He could eat smaller portions.

• He could read Nutrition Facts labels to make sure he eats foods that are lower

in calories, saturated and trans fat, cholesterol, sodium, and added sugar.

• He could eat more fruits, vegetables, whole grains, fat-free or low-fat milk

products, and lactose-free products.

• What else can Jose do to lose weight and lower his blood pressure?

• Jose could get 30 to 60 minutes of physical activity every day.

• He could dance or practice tai chi or yoga while he watches television.

• He could watch less television and walk or bike to a park, library, or fresh

foods market.

• He could take his high blood pressure medicine as his doctor instructs.

• Ask the following questions:

• What are some of the lessons we learned from these scenarios?

• Is there any part of a scenario that is similar to your own life?

Note: Allow 5 minutes for open discussion.

302 Healthy Heart, Healthy Family: A Community Health Worker’s Manual for the Filipino Community

6. Ampalaya (Bitter Melon) With Pork Recipe

Note: This activity will give group members a chance to try a heart healthy recipe at home.

• Give group members the “Ampalaya (Bitter Melon) With Pork Recipe” handout (page 319).

This dish contains lean meat and vegetables. It is also seasoned with herbs and spices. Try to prepare this at home this week.

7. Cooking With Children

• Give group members the “Cooking With Children” and “Cantaloupe Crush Recipe for Children” handouts (pages 320–322).
• Ask volunteers to read the “Cooking With Children” handout out loud.

If you are parents, you can teach your children healthy eating habits. Lola says often, “Ang gawa sa pagkabata, dala hanggang pagtanda.” “What one learns in childhood is carried into adulthood.”

For good health and proper growth, children need to eat a variety of different foods every day. If children are provided a balanced diet, they will develop good eating habits.

The cantaloupe crush is a drink made from fresh fruit and milk. Children love this drink, especially on hot, summer days.

• Ask:

Can you think of other ways to get children involved in helping to prepare healthy meals?

Session 8. Welcome Heart Healthy Eating Into Your Home 303

• Write group members’ suggestions on the blackboard or on a large piece of paper taped to the wall.

More Information

We Can! (Ways to Enhance Children’s Activity & Nutrition) is an education program to help children aged 8 to 13 maintain a healthy weight. The program includes tips for parents on healthy food choices and physical activity. Visit http://wecan.nhlbi.nih.gov.

Review of Today’s Key Points

Let’s review what we learned today.

• Ask:

What is heart healthy about the traditional Filipino diet?

• The traditional Filipino diet provides a variety of foods that are lower in fat

and sodium, such as steamed rice, bread, noodles, vegetables, fruits, lean meat, poultry, fish and seafood, low-fat and fat-free milk and milk products.

What are some foods that we should eat less often?

We should limit foods that are high in saturated fat, trans fat, sodium, added sugar, and calories, including:

• Foods high in fat, such as longanisa (native sausage), fried lumpia (egg roll),

sinangag (garlic fried rice), fried meat and vegetables, fatty meats, canned and processed meat, high-fat cheeses and creams, and banana chips

• Foods high in sodium, such as chips, canned meat and fish, and sauces and

seasonings, such as patis (fish sauce), bagoong (salted fish or shrimp paste), pusit (dried, salty squid), vetsin or monosodium glutamate, and soy sauce

304 Healthy Heart, Healthy Family: A Community Health Worker’s Manual for the Filipino Community

• Foods high in added sugar, such as candy and soft drinks

• Foods high in fat and added sugar, such as halo-halo, bibingka (cake with

coconut milk and butter), pastries, cookies, and chocolate

How can the heart healthy eating plan be used to choose heart healthy foods?

• Use the heart healthy eating plan to choose foods that are lower in saturated

fat, trans fat, cholesterol, sodium, and sugar from each of the five food groups. The eating plan also shows the number of servings you need from each group every day.

Why is it helpful to know how much you need to eat from each food group each day?

• When you know the amount of food you need to eat every day, it can help

you get the right amount of calories you need.

Lola’s Life Lessons: A Time To Reflect

In the last session, Lola Idad spoke to us about having the courage to be fearless. This week, Lola promotes heart health in our families by encouraging us to support each other in our efforts.

• Give each group member the “Lola’s Life Lessons: Session 8” handout (page 323). Ask a volunteer to read the handout.

Please take a few moments to reflect on Lola’s advice and how this applies to your life. At the bottom of the handout, there is a space called “A Time To Reflect.” Use this section to record your feelings about this week’s session. Please write down your thoughts. Remember, this is for you and no one else.

• Give each group member 2 to 3 minutes to write down some thoughts.

Session 8. Welcome Heart Healthy Eating Into Your Home 305

Pledge for Life!

• Give each group member the “Pledge for Life! Session 8” handout (page 324).

Take the pledge for life with Lola and her family. Pledge to do one thing on this list during the coming week. Now, let’s start by sharing our goals with each other.

Note: Tell group members to be very specific about what they plan to do. (For example, if they say they will eat smaller portions, ask them to name some ways they can do this.)

• Give each group member 2 to 3 minutes to share.

Closing

Thank you for coming today. What did you think of today’s session?

Note: Allow a moment for group members to respond.

I am looking forward to seeing you again at the next session. We will talk about eating in a heart healthy way—even when time or money is tight.

Note for Educator: Think about today’s session. What worked and what did not work? Have you made healthy changes in your food choices that were covered in today’s session?

306 Healthy Heart, Healthy Family: A Community Health Worker’s Manual for the Filipino Community

Heart Healthy Eating Plan

Grains

Rice, bread, cereal, and noodles (pasta) (6 to 8 servings a day)*

Fruits

(4 to 5 servings a day)*

Vegetables

(without added fat) (4 to 5 servings a day)*

Fat-free and low-fat milk and milk products

Milk, yogurt, and cheese (choose low-fat more often) (2 to 3 servings a day)*

Lean meats, poultry, and fish

Meat, poultry, fish, seafood, dry beans, eggs, tofu, and nuts (2 or fewer servings a day)*

Nuts, seeds, and legumes

(4 to 5 servings a week)

Fats and oils

(2 to 3 servings day)*

Sweets and added sugars

(5 servings or fewer a week)*

♥ Noodles and steamed rice ♥ Sliced bread (such as wheat, rye, or white), sandwich

buns, dinner rolls, English muffins, bagels, and pan de sal

♥ Unsalted, low-fat crackers (such as graham crackers),

unsalted pretzels, and plain popcorn

♥ Cooked hot cereals (not instant) and whole-grain cold

cereals

♥ Fresh, frozen, canned (packed in fruit juice), or dried fruits

without added sugar (such as oranges, papaya, grapefruit, bananas, apples, mangoes, pineapples, watermelon, peaches, fruit cocktail, grapes with skin on, and raisins)

♥ Fresh, frozen, or canned fruit juices (with no sugar added) ♥ Fresh, frozen, or no-salt-added canned vegetables (such

as peas, green beans, carrots, cabbage, tomatoes, yuca, squash, broccoli, potatoes, and corn

♥ Cooked dry beans, peas, and lentils

♥ Lactose-free products, such as soy milk and other

soy products

♥ Fat-free or low-fat (1%) milk ♥ Fat-free or low-fat yogurt ♥ Cheeses low in fat and sodium

♥ Chicken or turkey without the skin ♥ Fish and seafood ♥ Lean cuts of meat ♥ Beef: round, sirloin, chuck, loin, and extra lean

ground beef

♥ Pork: leg, shoulder, tenderloin, and lean ham ♥ Tofu ♥ Dry beans and peas (black beans, pinto beans, kidney

beans, navy beans, chickpeas, lentils, and split peas)

♥ Frozen butter beans and lima beans ♥ Eggs (no more than four yolks a week) ♥ Nuts, peanut butter, and seeds

♥ Margarine (liquid, soft tub, or reduced-calorie) ♥ Oils (canola, corn, safflower, olive, peanut, or sesame)

♥ Frozen treats (such as frozen juice pops, low-fat frozen

yogurt, or ice cream)

♥ Low-fat cake and cookies (such as angelfood cake, fig-bar

cookies, gingersnaps, animal crackers, vanilla wafers, graham crackers, puto, and mamon)

• The amount of food from each food group that is right for you depends on how many calories you need. This is based on your age, gender, and how physically active you are.

HANDO

Plano sa Pagkaing Malusog sa Puso

Mga Butil

Kanin, tinapay, cereal, at mga noodles (pasta) (6 hanggang 8 takal sa isang araw)*

Mga Prutas

(4 hanggang 5 takal sa isang araw)*

Mga Gulay

(nang walang idinagdag na taba) (4 hanggang 5 takal sa isang araw)*

Fat-free at lowfat na gatas at mga produktong gawa sa gatas

Gatas, yogurt, at keso (Piliin ang low-fat nang mas madalas) (2 hanggang 3 takal sa isang araw)*

♥ Mga noodles at sinaing na kanin

♥ Putol ng tinapay (tulad ng wheat, rye, o puti), mga

sandwich bun, dinner roll, English muffin, bagel, at pan de sal

♥ Walang asin, mga low-fat crackers (tulad ng graham

crackers), walang asin na mga pretzel, at walang halong popcorn

♥ Mga lutong mainit na cereal (hindi instant) at buong

butil na cereal

♥ Sariwa, naka-freeze, de lata (nakapaketeng katas ng

prutas), o mga pinatuyong prutas nang walang dinagdag na asukal (tulad ng mga kahel, papaya, grapefruit, saging, mansanas, manga, pinya, pakwan, peach, fruit cocktail, ubas na may balat, at pasas)

♥ Sariwa, naka-freeze, o de latang katas ng prutas (nang

walang idinagdag na asukal)

♥ Sariwa, naka-freeze, o walang idinagdag na asin sa de

latang gulay (tulad ng mga garbanzos, green beans, carrot, repolyo, kamatis, yuca, kalabasa, broccoli, patatas, at mais

♥ Mga lutong tuyong beans, garbanzos, at patani

♥ Mga produktong lactose-free, tulad ng gatas ng soya at

iba pang mga produktong gawa sa soya

♥ Gatas na fat-free o low-fat (1%)

♥ Yogurt na fat-free o low-fat (1%)

♥ Mga kesong mababa sa taba at asin

• Ang dami ng pagkain mula sa bawat pangkat ng pagkain na tama para sa iyo ay depende sa kung gaano karaming calorie ang kailangan mo. Ito ay batay sa iyong gulang at kasarian at kung gaano ka kaaktibong pisikal.

HANDOuT—SESSION 8

Plano sa Pagkaing Malusog sa Puso

Mga karneng kakaunti ang taba, manok, at isda

Karne, manok, isda, pagkaing dagat, mga tuyong beans, itlog, tokwa, at nut (2 o mas mababa pang takal sa isang araw)*

Mga nut, buto, at legumes

(4 hanggang 5 takal sa isang linggo)*

Mga fats at oils

(2 hanggang 3 takal sa isang araw)*

Mga matatamis at idinagdag na asukal

(5 takal o mas mababa pa sa isang linggo)*

♥ Manok o pabo na walang balat

♥ Isda at pagkaing dagat

♥ Mga hiwa ng karne na kakaunti ang taba

Baka: round, sirloin, chuck, loin, at sobrang kakaunti ang tabang giniling na baka

Baboy: pata, shoulder, tenderloin, at walang tabang hamon

♥ Tokwa

♥ Mga tuyong bean at garbanzos (mga black beans, pinto

beans, kidney beans, navy beans, chickpeas, patani, at split peas)

♥ Mga naka-freeze na butter beans at lima beans

♥ Mga itlog (hindi higit sa apat na pula ng itlog sa

isang linggo)

♥ Mga nut, peanut butter, at buto

♥ Margarine (likido, soft-tub, o binawasan ng calorie)

♥ Oils (canola, corn, safflower, olive, peanut, o sesame)

♥ Mga frozen treats (tulad ng naka-freeze na juice pops,

naka-freeze na low-fat yogurt, o sorbetes)

♥ Low-fat na keyk at mga cookies (tulad ng angelfood

cake, mga fig bar cookies, gingersnaps, mga biskwit na hugis hayop, vanilla wafers, graham crackers, puto, at mamon)

• Ang dami ng pagkain mula sa bawat pangkat ng pagkain na tama para sa iyo ay depende sa kung gaano karaming calorie ang kailangan mo. Ito ay batay sa iyong gulang at kasarian at kung gaano ka kaaktibong pisikal.

HANDOuT—SESSION 8 309

Add Color and Flavor to Your Menu

Omelet

Pan de sal

Coffee with fat-free milk

____________

Vegetable

____________

Fruit

BREAkFAST

HANDOuT—SESSION 8

Add Color and Flavor to Your Menu (continued)

LuNCH

Grilled fish

Steamed rice

____________

Vegetable

____________

Vegetable

____________

Fruit

HANDOuT—SESSION 8 311

Add Color and Flavor to Your Menu

Roasted pork

Noodles

____________

Vegetable

____________

Vegetable

____________

Fruit

DINNER

HANDOuT—SESSION 8

Add Color and Flavor to Your Menu

SNACk

____________

Vegetable

____________

Fruit

HANDOuT—SESSION

8 313

Say Yes to Fruits and Vegetables

Vegetables

Frozen peas Green beans Spinach and carrots

Tomatoes Bok choy Eggplant (pechay)

Pepper Green onions Cucumber

Broccoli

Sweet Potato (camote)

Cabbage

Cut out these foods, and use them for the activity.

314 HANDOuT—SESSION 8

Say Yes to Fruits and Vegetables (continued)

Fruits

Cherries Grapefruit Canned peaches Papaya in fruit juice

Banana Orange Apple Grapes

Pineapple Mango Peach Guava

Cut out these foods, and use them for the activity.

HANDOuT—SESSION 8 315

Heart Healthy Scenarios With the de la Cruz Family

• Scene 1: Helena’s Fast Food Dilemma Mila’s friend Helena is a busy, working mom with two children. She rarely makes dinner for her family because of her busy schedule. Three or four days a week, Helena takes her children to fast food restaurants. Her sons love eating hamburgers and french fries, drinking soda, and getting free toys. But she wants her children to live healthy lives. She is worried that they are spending too much time playing video games and watching television after school and meals. Combined with the fast food, Helena is worried that her sons will become overweight soon.

What can Helena do on her busy schedule to feed her children healthier meals?

What else can Helena do to help her children live healthy lives?

316 HANDOuT—SESSION 8

Heart Healthy Scenarios With the de la Cruz Family (continued)

• Scene 2: Cesar and Mila’s Parties Cesar and Mila like to have parties at their house. They enjoy the company of their family and friends. They usually celebrate with a lot of food and drink. They love to make chicken, leaving the skin on it, pancit, fried lumpia with pork, sinangag (garlic fried rice) with a lot of patis (fish sauce), and sweet desserts. Their gatherings start in the afternoon and usually last through the evening. Most of the time, they are sitting down eating and drinking alcohol. At least once a week, Cesar and Mila’s friends take turns hosting parties at their houses.

What can Cesar and Mila make for their own parties or bring to friends’ parties to make the celebrations more heart healthy?

How can Cesar and Mila stick to their healthier eating plan when they are at the parties?

What else can Cesar and Mila do?

HANDOuT—SESSION 8 317

Heart Healthy Scenarios With the de la Cruz Family (continued)

• Scene 3: Eating When Stressed or Bored Jose is trying to stay heart healthy. His doctor says he needs to lower his blood pressure and lose some weight. But eating makes him feel better when he is stressed or bored. He says it takes his mind off his problems. Even when he is not hungry, Jose likes to snack on pork rinds, salted peanuts, and regular sodas while watching television.

How can Jose eat better to lose weight and lower his blood pressure?

What else can Jose do to lose weight and lower his blood pressure?

318 HANDOuT—SESSION 8

(Bitter Melon) With Pork Recipe

1 tablespoon olive oil ½ pound (0.2 kg) lean ground pork 6 cloves garlic, crushed 1 cup onion, 1 medium, chopped

2 cups 2 teaspoons ½ teaspoon

Ampalaya,* sliced light soy sauce black pepper

• Ampalaya (bitter melon) is a fruit that is oblong,

cylindrical, pointed at both ends, ribbed, and wrinkled.

Quick Facts

This recipe is lower in fat and sodium because it uses:

• Lean meat that is sauteed and simmered instead of fried
• Onion, garlic, and bitter melon for flavor
• Low-sodium soy sauce that reduces the amount of sodium in the dish

Source: Adapted from Heart Healthy Traditional Filipino Recipes, American Heart Association.

1. Using a large skillet, lightly saute onions

and garlic in hot olive oil.

1. Add the ground pork and cook until

almost done.

1. Add the sliced bitter melon.
2. Cover and simmer until bitter melon

turns green. Do not overcook.

1. Season with light soy sauce and

black pepper.

Yield: Serving size: 4 servings 1 cup Calories 150 kcal Total Fat 6 g Saturated Fat 1.5 g Cholesterol 45 mg Sodium 200 mg Total Fiber 1 g Protein 17 g Carbohydrates 7 g Potassium 600 mg

SESSION

Cooking With Children

Get Them Interested

Cooking with your children is a good way to help them develop healthy eating habits. Most children enjoy helping in the kitchen. While they help you prepare a meal, you can talk to them about healthy foods. Children like to eat the food they make. This is also a good way to get them to try more healthy foods.

Let Them Help

You can show your children how to help you prepare meals. Here are ways that children of different ages can help in the kitchen:

2-year-olds can:

• Wipe tabletops. • Tear lettuce or greens.
• Scrub and rinse fruits • Break up broccoli.

and vegetables.

• Bring ingredients from one place to another.

3-year-olds can:

• Wrap potatoes in foil for baking.
• Knead and shape dough for

ensaymada (sweet bread).

• Mix ingredients.
• Pour liquids.
• Shake liquids in a covered container.
• Apply soft spreads.
• Shape the edges of the empanadas.
• Wrap lumpia rolls.
• Make dumplings.
• Put things in the trash.

4-year-olds can:

• Peel oranges or hard-boiled eggs. • Cut basil with kid-safe scissors.
• Mash bananas with a fork. • Set the table.

5- to 6-year-olds can:

• Measure ingredients. • Cut crusts off bread for sandwiches.
• Use an egg beater.

Be sure to have children wash their hands before and after helping in the kitchen. Be patient with spills and mistakes. Remember that the goal is to help your children learn about healthy eating.

320 HANDOuT—SESSION 8

Cooking With Children (continued)

Let Them Be Creative

Set out three or four healthy foods, and let your children make a new snack or sandwich from them. Use foods your children can eat without choking.

Start with:

• A new kind of bread (whole grain or rye)
• Whole-grain crackers or graham crackers
• Mini rice cakes or popcorn cakes
• Small bagels
• Salt-free crackers

Spreads could include:

• Low-fat cream cheese or cheese spread • Jelly or jam with no sugar added
• Low-fat peanut butter

Toppings could include:

• Slices of banana, pineapple, or cherries • Raisins or other dried fruit • Strawberries

• Cherry tomatoes cut in small pieces • Slices of cheese or hard-boiled egg • Basil leaves or dill

• Slices of cucumber or squash

As you help your children make the new snack or sandwich, talk about why it is healthy.

Point out the different food groups that are included in the snack or sandwich. Explain that eating a variety of foods is healthy.

Ask why the snack or sandwich tastes good. Is it sweet, juicy, chewy, or crunchy?

Adapted from the U.S. Department of Agriculture, “Tips for Using the Food Guide Pyramid for Young Children 4 to 6 Years Old.”

HANDOuT—SESSION 8 321

Cantaloupe Crush Recipe for Children

½ 1 cup 1½ cups sweetener

cantaloupe fat-free milk ice as needed (about 1 to

2 teaspoons sugar or equivalent of other sweetener)

Quick Facts

This refreshing drink is healthy because it uses:

• Fresh fruit
• Fat-free milk
• Low amounts of sweetener

Source: National Cancer Institute recipe at InteliHealth, available at:

1. Cut cantaloupe into small cubes or

thin strips.

1. Mix cantaloupe, milk, and ice in a

blender until smooth.

1. Sweeten to taste.

Yield: Serving size: 4 servings ½ cup Calories 50 kcal Total Fat 0 g Saturated Fat 0 g Cholesterol 0 mg Sodium 40 mg Total Fiber 0 g Protein 3 g Carbohydrates 10 g Potassium 280 mg

http://www.intelihealth.com/IH/ihtIH/WSSAN283/2372/14218/232586.html?sID=325

Lola’s Life Lessons: Session 8

One of my favorite proverbs is:

“Ang mabigat ay gumagaan, kung pinatutulngan.”

Translation: “A heavy burden is lightened if everyone participates in carrying it.”

The journey to heart health has many challenges. But it is much easier if your family and friends support you. When I first started changing my eating habits, it was hard to go to parties and gatherings. The parties always have delicious dishes on the table, but the sauces are usually high in fat and sodium. In the beginning, I would taste everything on the table because I did not want to offend the host. Sometimes, I would try to go to the gatherings after dinner was served, because it made it easier to say no.

Eventually, I learned to eat smaller portions of my favorite foods. It is a lot easier now that my family has joined me on the journey to heart health. We bring low-fat, low-sodium dishes to share at potluck dinners. At parties, we remind each other to eat well-balanced meals. But I am most proud of my grandchildren, who are following their parents’ example by making smart, healthy food choices each day.

A Time To Reflect…

What changes has your family made in order to become heart healthy? What new changes can you make to support your family’s journey to heart health?

(Use this space to write down your thoughts for this week’s session.)

HANDOuT—SESSION 8 323

Pledge for Life! Session 8

Take the pledge for life with Lola Idad. Try to do one of these activities by yourself or share with others.

Learn the serving sizes for foods.

Limit the intake of saturated and trans fat, cholesterol, and sodium, as well as added sugar.

Eat smaller portions of food, starting with smaller portions of meat, steamed rice, and noodles.

Avoid having second helpings of food.

Choose a variety of fruits and unsalted nuts for healthy snacks.

Bring carrot and celery sticks to work for a snack.

Add fruits, like bananas or raisins, to cereal or oatmeal.

Choose fewer snacks that are high in fat, sodium, and added sugar.

Choose water or sugar-free drinks.

Share heart healthy recipes with your family and friends.

Other

324 HANDOuT—SESSION 8

s essi o n

Eat in a Heart Healthy Way—Even When Time or Money Is Tight

Objectives

By the end of this session, group members will learn:

• Quick and easy food preparation and mealtime tips
• How to eat out in a heart healthy way
• How to save money on food bills

Materials and Supplies

To conduct this session, you will need:

• “Healthy Heart, Healthy Family” manual and picture cards
• Examples of advertisements from magazines*
• Blackboard and chalk or several large pieces of paper, markers, and tape
• Pencils
• Prepare before the session.

Session 9. Eat in a Heart Healthy Way—Even When Time or Money Is Tight 325

Handouts

Give each group member these handouts during this session:

• “Tips for Busy Families” (pages 344–346)
• “Rose’s Busy Schedule” (page 347)
• “Lola’s Tips for Heart Healthy Chinese Food” (pages 348–349)
• “Tips for Eating Out the Heart Healthy Way” (pages 350–352)
• (Optional) “Eating Out With the de la Cruz Family Role Play” (page 353)
• “Money-Saving Tips” (page 354)
• “Shopping List” (page 355)
• “Vegetable Kare-Kare (Peanut Stew) Recipe” (page 357)
• “Lola’s Life Lessons: Session 9” (page 358)
• “Pledge for Life! Session 9” (page 359)

Session Outline

Introducing the Session

1. Welcome
2. Review of Last Week’s Session
3. About This Session

Conducting the Session

1. Eat in a Heart Healthy Way Even When There Is Little Time

A. Busy Times

326 Healthy Heart, Healthy Family: A Community Health Worker’s Manual for the Filipino Community

B. Quick and Easy Meal Tips

C. Eating Out

1. Save Money on Your Food Bill

Money-Saving Tips

1. Food Advertising Activity
2. Vegetable Kare-Kare (Peanut Stew) Recipe

Review of Today’s Key Points

Lola’s Life Lessons: A Time To Reflect

Pledge for Life!

Closing

Introducing the Session

1. Welcome

Welcome group members to the session.

2. Review of Last Week’s Session

Let’s review some of the lessons we learned last session.

Session 9. Eat in a Heart Healthy Way—Even When Time or Money Is Tight 327

• Ask:

What is heart healthy about the traditional Filipino diet?

The traditional Filipino diet provides a variety of foods that are lower in fat and sodium, such as bread, noodles (pasta), steamed rice, vegetables, fruits, poultry, fish and seafood, low-fat and fat-free milk and milk products, and lactose-free products such as soy milk.

What are some foods that we should eat less often?

We should limit foods that are high in saturated fat, trans fat, sodium, sugar, and calories, including:

• High-fat foods, such as longanisa (native sausage), fried lumpia (egg roll),

sinangag (garlic fried rice), fried meat and vegetables, fatty meats, canned and processed meat, high-fat cheeses and creams, and banana chips

• Salty foods and sauces, such as potato chips and bagoong

• High-fat and high-sugar foods, such as bibingka (sweet rice cake) and other

pastries, cookies, and chocolate

• Sugary foods, such as candy and soft drinks

How can the heart healthy eating plan be used to choose heart healthy foods?

Use the heart healthy eating plan to choose foods that are lower in saturated fat, trans fat, cholesterol, sodium, and sugar from each of the five major food groups. The eating plan also shows you the number of servings that you need from each group every day.

Why is it helpful to know how much you need to eat from each food group each day?

When you know the correct amounts of food you need to eat every day, it can help you get the right amount of calories you need.

328 Healthy Heart, Healthy Family: A Community Health Worker’s Manual for the Filipino Community

• Ask:

Would anyone like to share his or her pledge from last week? What went well? What did not work well?

Note: Allow about 2 to 3 minutes for group members to respond.

3. About This Session

Today, you will learn how to eat in a heart healthy way—even when you have very little time and are on a tight budget. During this session, you will learn:

• Quick and easy ways to prepare heart healthy meals

• How to eat right when eating out

• How to make smart food-buying choices that meet your family’s needs

and budget

• How advertising can cause us to buy things that cost more or things we do

not need

According to Lola Idad, “Ang taong matalino ay hindi tumitingin sa pagyapak ng paa niya sa lupa. Binabantayan niya ang kanyang kasunod na hakbang.” “A wise man does not see his foot on the ground; he watches his next step.”

Lola encourages her family to make heart healthy eating a priority. Her family will share some tips on how to eat heart healthy meals on a budget later in this session.

Session 9. Eat in a Heart Healthy Way—Even When Time or Money Is Tight 329

Conducting the Session

1. Eat in a Heart Healthy Way Even When There Is Little Time

A. Busy Times

Many people have little time to shop, prepare food, and clean up after meals. This session will help you eat in a heart healthy way, even when you are in a rush.

Busy people may think they do not have time to eat in a heart healthy way. These people may:

• Skip breakfast and lunch, and eat one big meal in the evening.

• Eat out or order carryout food several times per week.

• Buy boxed, instant, or already-prepared foods.

• Buy food from vending machines.

• Ask:

What foods do you eat when you don’t have time to cook?

Note: Allow about 5 minutes for group members to respond. Write their answers on the blackboard or on a large piece of paper taped to the wall.

330 Healthy Heart, Healthy Family: A Community Health Worker’s Manual for the Filipino Community

Eating on the run often means that we are eating foods that are higher in fat, sodium, sugar, and calories. For example, we eat snacks and candy from vending machines or high-fat hotdogs and fried foods from fast food restaurants.

People often eat these foods because they are easy to buy or quick to prepare. When people are in a hurry, they often do not think about what kinds of foods are heart healthy.

They may also eat bigger portions of foods that are higher in fat and calories when there is no time to prepare healthy side dishes, such as salad, vegetables, or steamed rice.

B. Quick and Easy Meal Tips

Note: This part of the session will help group members think about ways to prepare meals in less time.

People often find that they are too tired to prepare the kinds of meals they would like their families to eat. Today, we will learn some ways to save time and make meal preparation easier.

• Give each group member the “Tips for Busy Families” handout (pages 344–346).

Note: Show picture cards when you review sections under “Tips for Busy Families.” Show picture card 9.1 when you review the “Plan Your Meals” and “Use a Shopping List” sections of the handout. Show picture card 9.2 when you review the “Cook in Advance” section.

• Ask for volunteers to read the tips aloud, one at a time. Allow group members to comment as the tips are read.

Session 9. Eat in a Heart Healthy Way—Even When Time or Money Is Tight 331

• Ask:

Would you find any of these tips difficult to carry out?

Note: Allow 3 to 5 minutes for group members to respond.

Group Activity

Note: This activity will help group members think about creative ways a family can enjoy heart healthy meals even when time is limited.

• Divide participants into groups of three or four people. Give group members the “Rose’s Busy Schedule” handout (page 347).

I am going to read a real-life situation. You can follow the story on the handout. Think about how Rose can solve her problem.

Rose’s Busy Schedule

Rose has a busy life. She has three young children, and she and her husband work Monday through Friday. Rose’s husband, Jose, leaves for work at 5:30 a.m. and gets home at 7:30 p.m. Rose usually leaves for the office at 9 a.m. and gets home around 6 p.m.

Every night, after she comes home from work, Rose gets the family’s dinner ready. She wants the family to be heart healthy, but she never seems to have the time to cook. Often, she is running late or is too tired to cook, so she picks up pizza, Chinese food, or fried chicken on her way home.

Since his stroke, Jose wants her to make healthier, traditional Filipino dinners. Rose tries to get her husband to help her with dinner, but he is always tired. Besides, Jose does not like cooking. They also have to help the children with their homework. This leaves them little time to prepare heart healthy meals.

332 Healthy Heart, Healthy Family: A Community Health Worker’s Manual for the Filipino Community

• Ask each small group to discuss ways that Rose can make sure her family eats in a heart healthy way.

Note: Allow about 5 minutes for the groups to come up with suggestions.

• Ask one person from each group to present his or her group’s suggestions to the entire group.
• Add these ideas if they are not mentioned:

• Rose could cook two or three meals over the weekend and store them in the

freezer.

• She could make meals in a slow cooker (Crock-Pot®), which saves time

during the evenings. Meals cook during the day and are ready when the family gets home.

• Rose’s family could help her by putting casseroles (from the freezer or made

the night before) into the oven before she gets home.

• Several families could get together and share meals.

• Rose’s family could help her by setting the table and doing the dishes.

• Rose could buy roasted chicken instead of fried.

• Rose could buy steamed fish or vegetable dishes (instead of fried) from the

Chinese restaurant.

C. Eating Out

Note: This activity will teach group members how to make heart healthy choices at fast food restaurants.

• Ask:

Where do you eat when you eat out?

Note: Allow about 3 minutes for group members to respond. Write their answers on the blackboard or on a large piece of paper taped to the wall.

Session 9. Eat in a Heart Healthy Way—Even When Time or Money Is Tight 333

Many people eat at fast food restaurants because:

• The food is served quickly.

• The food tastes good.

• The food is less expensive than food at sitdown restaurants.

• Special food and toys appeal to children.

• There may be a playground for children.

Many fast foods can be higher in saturated fat, sodium, and calories, but you can choose healthier foods from the menu.

• Show picture card 9.3. Keep it on display while you review the handout.
• Give each group member the “Lola’s Tips for Heart Healthy Chinese Food” handout (pages 348–349) and “Tips for Eating Out the Heart Healthy Way” handout (pages 350–352).
• Ask for volunteers to read the suggestions on the handouts aloud.

Do you have other ideas for making heart healthy choices at restaurants?

Note: Allow 2 or 3 minutes for group members to respond. Write their answers on the blackboard or on a large piece of paper taped to the wall.

Let’s talk briefly about buffet-style and “all-you-can-eat” restaurants. They may seem like money-saving restaurant choices that allow you to enjoy your favorite dishes at one time. But you may be tempted to overeat at these restaurants in order to get “the most” for your money. Try choosing buffet and “all-you-caneat” restaurants less often.

334 Healthy Heart, Healthy Family: A Community Health Worker’s Manual for the Filipino Community

If you do go to a buffet-style restaurant, make heart healthy choices, such as baked, steamed, broiled, and grilled lean meats and fish, and steamed or sauteed vegetables without sauces. Many of the sauces are high in sodium and calories. Also, watch your portions. It isn’t a good deal to overeat because, eventually, you may pay a price with your health.

Let’s talk about how the de la Cruz family handles eating out at their favorite Chinese buffet restaurant.

• (Optional) Give each group member the “Eating Out With the de la Cruz Family Role Play” handout (page 353). Ask for three volunteers to be actors for the role play.

Note: Allow 5 minutes for open discussion.

• Ask the following questions:

• What are some of the lessons we learned from this role play?

• Is there any part of the play that you can use in your own life?

2. Save Money on Your Food Bill

Money-Saving Tips

• Ask:

What do you do to save money on food?

Note: Allow about 5 minutes for group members to respond. Write their answers on the blackboard or on a large piece of paper taped to the wall.

There are things you can do to save money on your food bill. Let’s go over a list of ideas.

Session 9. Eat in a Heart Healthy Way—Even When Time or Money Is Tight 335

• Give each group member the “Money-Saving Tips” handout (page 354). Ask for volunteers to read the tips aloud.
• Give each group member the “Shopping List” handout (page 355).

You can use this shopping list when you go to the store. Just check off or write on the blank lines what you want to buy.

The items on the second list are lower in saturated fat, trans fat, and sodium. These foods also make easy, healthy snacks and can be added to bag lunches or used as ingredients for main dishes.

These lists show us that eating heart healthy on a tight budget is possible. Remember to plan ahead and make smart, heart healthy choices when you are at the grocery store. This will help you stay within your budget.

3. Food Advertising Activity

Note: This section will help group members become more aware of how advertising plays into their food-buying decisions.

336 Healthy Heart, Healthy Family: A Community Health Worker’s Manual for the Filipino Community

Food advertising is big business.

• Advertisements try to get adults and children to buy certain products.

• Advertising costs money. Billions of dollars are spent on food advertising.

The people buying the food—the consumers—pay for this.

• Nationally advertised items usually cost more than store brands and brands

that are not nationally advertised.

• Most people are more likely to buy items with fancy, eye-catching packaging.

• People can be very loyal to certain brands. They will often buy these

products even if they cost more.

• Ask group members to describe advertisements that have persuaded them to buy certain products.

Note: Allow about 3 minutes for group members to respond.

• Review different advertising themes that are used to get people to buy food products. (Show or describe an example of the following advertising themes. Prepare these examples before the session.)

Note: As you discuss the six themes, write them on the blackboard or on a large piece of paper taped to the wall. You will need these themes for the group activities.

Popular advertising themes often focus on family, health, sex appeal, humor, appearance, and famous people.

• Family

Advertisers try to get you to use their products based on your love for your family. This works well because the family plays an important role in the Filipino community. Ads with a family theme often target women because of their role as family caregivers.

Session 9. Eat in a Heart Healthy Way—Even When Time or Money Is Tight 337

• Health

Some advertisements focus on the positive health effects of using certain products. This works because people care about their health.

• Sex appeal

Sex appeal sells products. Many people want to believe that they also will be beautiful and sexy if they use the advertised product.

• Humor

A funny advertisement often helps people remember a product.

• Appearance

Food advertisers show food that may look better than the real thing. This makes people want to try the product.

• Famous people

Famous people are used to sell products. Advertisers can also have a celebrity use a product in a television show or movie.

Group Activity

Note: This activity will help group members think about how advertising affects how we buy food.

• Divide the group members into smaller groups of three or four people. Give each group two to three advertisements that you have collected.

I have given you real advertisements. Discuss with your group which themes are used in the advertisements.

Note: Allow about 5 minutes for the groups to come up with their ideas.

• Ask one person from each group to present his or her group’s ideas to the others.

Advertising can be helpful, because it tells people about different products they can buy. But ads can also get people to buy products that they do not need or cannot afford, or products that appear better than they really are.

338 Healthy Heart, Healthy Family: A Community Health Worker’s Manual for the Filipino Community

• Ask:

What can you ask yourself when you are trying to decide what brand to buy?

Note: Allow 4 to 5 minutes for group members to respond.

• Add the following questions if they are not mentioned:

• Do I really need it?

• Is there a less expensive product that serves the same purpose?

• Have I compared the product’s Nutrition Facts label with an item that

costs less?

• Am I buying the product because it comes in a nice package?

• Am I buying the product because the advertisement says it will make me look

better or help me lose weight?

• Am I buying it because I have a coupon or because it’s on sale?

• Can I afford it, even with a coupon?

• Can I wait until it goes on sale?

Even if you want to buy name brands, you can save money by buying the products when they are on sale.

4. Vegetable Kare-Kare (Peanut Stew) Recipe

• Give group members the “Vegetable Kare-Kare (Peanut Stew) Recipe” handout (page 357). Ask them to try this dish sometime this week.
• Ask:

How can this dish help us eat in a heart healthy way when we have little time?

Session 9. Eat in a Heart Healthy Way—Even When Time or Money Is Tight 339

• Add these answers if they are not mentioned:

• This dish can be prepared in advance and frozen, so you can save time.

• It includes a lot of vegetables.

Review of Today’s Key Points

Let’s review what we learned today.

What can you do to save time in meal preparation?

• Get help from your spouse.

• Cook several dishes at one time, and freeze part of them.

• Make larger quantities, and use the leftovers for lunch.

• Pack lunches the night before.

• Learn simple, fast recipes.

• Use a slow cooker.

What can you do to eat healthier when eating out?

• Try choosing buffet and “all-you-can-eat” restaurants less often.

• Order sandwiches without mayonnaise or sauces (or with low-fat mayonnaise

or sauces).

• Order small, plain hamburgers or lean roast or chicken sandwiches instead of

deluxe sandwiches.

• Ask for low-fat salad dressing, or bring your own.

• Choose water, 100% fruit juice, or fat-free or low-fat (1%) milk instead of a

soft drink or a milkshake.

340 Healthy Heart, Healthy Family: A Community Health Worker’s Manual for the Filipino Community

• Order smaller portions.

• Choose baked, broiled, steamed, or grilled foods instead of fried foods.

• Order steamed rice instead of fried rice at Asian restaurants.

• Remove the skin from chicken, and do not eat it.

• Choose vegetarian pizza, and ask for less cheese.

• Order a green vegetable or salad instead of two or more starches (such as

potatoes, rice, noodles, bread, and corn).

• Make sure the restaurant does not use monosodium glutamate (MSG) in

the dishes.

• Use less soy sauce or use light soy sauce. Try other low-sodium sauces or

herbs to flavor foods.

What can you do to save money when shopping?

• Plan weekly meals, and make a shopping list of what you need to buy for the

week.

• Use a shopping list, and don’t go to the store too often.

• Check the food sale ads.

• Choose prepared foods less often.

• Buy only the amount of food your family needs.

• Shop alone, when possible, and make sure you’re not hungry.

• Check your receipt for errors at the cash register.

• Try not to shop at convenience stores.

• Try store brands, and use them as often as possible.

Session 9. Eat in a Heart Healthy Way—Even When Time or Money Is Tight 341

Lola’s Life Lessons: A Time To Reflect

Last week, Lola Idad reminded us of the important role our families play in our journey to heart health. This week, Lola shows us how planning ahead can keep our budgets balanced and our lives heart healthy.

• Give each group member the “Lola’s Life Lessons: Session 9” handout (page 358). Ask a volunteer to read the handout.

Please take a few moments to reflect on Lola’s advice and how this applies to your life. At the bottom of the handout, there is a space called “A Time To Reflect.” Use this section to record your feelings about this week’s session. Please write down your thoughts. Remember, this is for you and no one else.

• Give each group member 2 to 3 minutes to write down some thoughts.

Pledge for Life!

• Give each group member the “Pledge for Life! Session 9” handout (page 359).

Take the pledge for life with Lola and her family. Pledge to do one heart healthy activity on the list to save time and money. Now, let’s start by sharing our goals with each other.

• Give each group member 2 to 3 minutes to share.

342 Healthy Heart, Healthy Family: A Community Health Worker’s Manual for the Filipino Community

Remember to continue using the skills you learned in other sessions, and keep working on your pledges to:

• Be physically active.

• Cut back on saturated fat, cholesterol, salt and sodium, and calories in

your diet.

• Keep a healthy weight.

Closing

Thank you for coming today. What did you think of today’s session?

Note: Allow a moment for group members to respond.

I am looking forward to seeing you at the next session. The next session will be on living smoke free.

Note for Educator: Think about today’s session. What worked and what did not work? Have you decided to make any changes to eat in a heart healthy way even when money and time are tight?

Session 9. Eat in a Heart Healthy Way—Even When Time or Money Is Tight 343

Tips for Busy Families

Plan Your Meals

♥ Plan weekly meals based on your family’s

schedule.

Use a Shopping List

♥ Save money and time by

making only one trip to the store. Make and use a shopping list.

Share Meal Preparation Tasks

♥ Teach your family how to shop for groceries. ♥ Include children and other members of your

family in preparing meals and cleaning up.

♥ Clean up as you cook—you will have less to

clean up after you finish cooking.

♥ Share cooking duties with other family

members or neighbors. For example, your family can cook enough food to share with another family.

Cook in Advance

♥ Prepare some foods in advance, such as

spaghetti sauce. Use these foods for quick meals. You can add chicken or beef to the sauce and serve it over spaghetti or rice.

♥ Prepare parts of a meal the night before (for

example, marinate chicken in the refrigerator overnight).

♥ Pack your lunch the night before. ♥ Cut and wash vegetables, and make enough

salad for 2 days. Do not add dressing until serving time.

♥ Cook two or three dishes on your day off, and

freeze some of them. Use the frozen dishes on the days when you do not have time to cook.

♥ Prepare for recipes the night before by cutting

and trimming meats.

♥ Prepare meals in a slow cooker.

Cook Simply

♥ Steam vegetables, and serve

them without sauces.

♥ Use frozen vegetables without sauces. ♥ Broil, steam, grill, bake, or roast meats. ♥ Make one-pot meals, such as stews and

casseroles.

♥ Use frozen chopped vegetables, such as

carrots, peas, and broccoli.

♥ Use the microwave for cooking or defrosting. ♥ Learn simple recipes that can be made in less

than 30 minutes.

Use Herbs and Spices

♥ Chop fresh herbs, and place in ice cube trays.

Fill trays with water, and freeze. Store the frozen cubes in a plastic bag. Use when you need fresh herbs.

♥ Grow bay leaves, basil, or thyme on a sunny

windowsill.

♥ Keep dried herbs on hand. One teaspoon of

dried herbs is equal to 3 teaspoons of fresh herbs.

Keep Quick Snacks on Hand

♥ Try these healthy snacks:

• Fresh fruits and vegetables
• Whole-grain, ready-to-eat, dry cereal
• Polvorones (whole-wheat candy)
• Fat-free and low-fat cheese
• Unsalted nuts, seeds, and crackers
• Whole-grain breads

u

Mga Payo para sa Mga Pamilya na Abala

Iplan ang Iyong Mga Pagkain

♥ Iplano ang lingguhang

mga pagkain batay sa iskedyul ng iyong pamilya.

Gumamit ng isang Listahan ng Pamimili

♥ Sa isang paglalakbay lamang papunta

sa tindahan ay makakatipid ng pera at oras. Gumawa at gumamit ng isang listahan ng pamimili.

Mga Gawain sa Paghahanda ng Pamamahagi ng Pagkain

♥ Turuan ang iyong pamilya kung paano

mamili sa mga groserya.

♥ Isama ang mga bata at ibang

mga miyembro ng iyong pamilya sa paghahanda ng mga pagkain at paglilinis.

♥ Maglinis habang nagluluto—konti

ang iyong lilinisan pagkatapos mong magluto.

♥ Ibahagi ang mga tungkulin sa pagluluto

sa ibang mga miyembro ng pamilya o mga kapitbahay. Halimbawa, ang iyong pamilya ay maaaring magluto ng sapat na pagkain upang maibahagi sa ibang pamilya.

Magluto ng mas Maaga

♥ Maghanda ng ilang mga pagkain ng

mas maaga, tulad ng sarsa ng spaghetti. Gamitin ang mga pagkaing ito para sa mabilisang mga pagkain. Maaari kang magdagdag ng manok o baka sa sarsa at ihain ito sa spaghetti o sa kanin.

♥ Ihanda kinagabihan ang mga bahagi ng

isang pagkain (halimbawa, ibabad ang manok nang magdamag sa refrigerator).

♥ Balutin kinagabihan ang iyong

tanghalian.

♥ Hiwain at hugasan ang mga gulay, at

gumawa ng sapat na ensalada para sa 2 araw. Huwag magdagdag ng dressing hanggang sa oras ng paghahain.

♥ Magluto ng dalawa o tatlong putahe

sa araw na wala kang pasok, ilagay sa freezer ang ilan sa mga ito. Gamitin ang naka-freeze na mga putahe sa mga araw na wala kang oras na magluto.

♥ Maghanda kinagabihan ng mga recipe

sa pamamagitan ng paghihiwa at pagbabawas ng mga karne.

♥ Ihanda ang mga pagkain sa isang

mabagal na pagluluto.

Mga Payo para sa Mga Pamilya na Abala

Magluto ng Simple

♥ Pausukan ang mga gulay at ihain ito ng

walang mga sarsa.

♥ Gumamit ng mga naka-freeze na gulay

na walang mga sarsa.

♥ Pakuluan, pausukan, ihawin, ihurno, o

ilitson ang mga karne.

♥ Gumawa ng isang kalderong mga

pagkain, tulad ng mga stew at casserole.

♥ Gumamit ng naka-freeze na tinilad-tilad

na mga gulay, tulad ng mga carrot, pea, at broccoli.

♥ Gamitin ang microwave para sa

pagluluto o pagde-defrost.

♥ Matuto ng mga simpleng recipe na

maaaring gawin na mas mababa sa 30 minuto.

Gumamit ng Mga Herb at Pampalasa

♥ Ihawain ang mga sariwang herb, at

ilagay sa mga trey ng yelo. Punuin ng tubig ang mga trey, at i-freeze. Iimbak ang mga yelo sa isang plastic bag. Gamitin kapag kinakailangan mo ng mga sariwang herb.

♥ Mag-alaga ng mga dahon ng laurel,

basil, o thyme sa isang naaarawang bintana.

♥ Palaging magtabi ng mga tuyong herb.

Ang isang kutsarita ng mga tuyong herb ay katumbas ng 3 kutsarita ng mga sariwang herb.

Laging Magtabi ng Mga Madaliang Minindal

♥ Subukan ang mga malusog na minindal

na ito:

• Mga sariwang prutas at gulay
• Buong butil, handa kainin, tuyong cereal
• Polvorones (buong wheat na kendi)
• Fat-free at low-fat na keso
• Mga maning walang asin, buto, at biskwit
• Mga buong butil na tinapay

O

Rose’s Busy Schedule

Rose has a busy life. She has three young children, and she and her husband both work Monday through Friday. Rose’s husband Jose leaves for work at 5:30 a.m. and gets home at 7:30 p.m. Rose usually leaves for the office at 9 a.m. and gets home around 6 p.m. Every night, after she comes home from work, Rose gets the family’s dinner ready. Rose wants the family to be heart healthy, but she never seems to have the time to cook. Often, she is running late or is too tired to cook, so she picks up pizza, Chinese food, or fried chicken on her way home.

Since his stroke, Jose wants her to make healthier, traditional Filipino dinners. Rose tries to get her husband to help her with dinner, but he is always tired. Besides, Jose does not like cooking. They also have to help the children with their homework. This leaves them little time to prepare heart healthy meals.

What can Rose do to make sure that her family eats in a heart healthy way? Write down some ideas for Rose to try:

HAndOuT—SESSIOn 9 347

Lola’s Tips for Heart Healthy Chinese Food

Here are Lola Idad’s tips for lowering fat and calories when you order food from a Chinese carryout restaurant.

Choose More Often Choose Less Often

• Steamed or grilled dishes, such as steamed dumplings or grilled fish, instead of fried dishes.

• Deep-fried dishes such as Kung Pao Chicken, General Tso’s Chicken, Mu Shu Pork, or fried egg rolls.

• More vegetable dishes or dishes that • Fried rice.

have large amounts of vegetables,

• Dishes with heavy sauces, such as

such as beef with broccoli. coconut milk.

• Steamed rice instead of fried

rice. (Steamed rice is lower in fat, cholesterol, and calories.)

AND . . . .

• Let the restaurant know your dietary needs, so they can suggest ways to meet

your needs, if possible.

• On the day you are planning to order Chinese food, eat foods with less sodium

in your other meals and snacks. Many dishes from Chinese restaurants are very high in sodium.

• You can cut down on the sodium in the Chinese food you order. Make sure the

restaurant does not use monosodium glutamate (MSG) in the dishes. MSG is high in sodium!

• You can also cut down on sodium by using light soy sauce to season the food.

• Instead of buffets, order healthy choices from the menu.

Source: Adapted from Asian Health Services, www.ahschc.org.

348 HAndOuT—SESSIOn 9

Mga Payo ni Lola para sa Malusog sa Pusong Pagkain ng Tsinos

Narito ang mga payo ni Lola Idad para sa pagpapababa ng taba at calorie kapag umorder ka ng pagkain mula sa isang restawran na Chinese carryout.

Piliin nang Mas Madalas ♥ Pinausukan o inihaw na mga pagkain, tulad ng mga pinausukang dumpling o inihaw na isda, sa halip na mga piniritong pagkain ♥ Mas maraming mga pagkaing

Piliin nang Hindi Madalas ♥ Mga pagkaing piniritong nakalubog sa mantika tulad ng Kung Pao Chicken, General Tso’s Chicken, Mu Shu Pork, o piniritong egg rolls ♥ Sinangag gulay o mga pagkain na mayroong

♥ Mga pagkaing masarsa, tulad ng gata

maraming mga gulay, tulad ng baka na may broccoli

♥ Sinaing na kanin sa halip na sinangag

(ang sinaing na kanin ay mas mababa sa taba, kolesterol, at mga calorie)

AT . . .

♥ Ipaalam sa restawran ang iyong mga pangangailangang pandiyeta, upang

makakapagmungkahi sila ng mga paraan upang maabot ang iyong mga pangangailangan, kung posible.

♥ Sa araw na pinaplano mong umorder ng pagkaing Tsino, Kumain ng mga pagkain na

kaunti ang asin sa iyong iba pang mga pagkain at meryenda. Maraming mga pagkain mula sa mga restawrang Tsino ay napakataas sa asin.

♥ Maaaring mong bawasan ang asin sa pagkaing Tsino na inorder mo. Tiyakin na ang

restawran ay hindi gumagamit ng monosodium glutamate (MSG) sa mga pagkain. Ang MSG ay mataas sa asin!

♥ Maaari mo ring bawasan ang asin sa pamamagitan ng paggamit ng light na toyo upang

matimplahan ang mga pagkain.

Pinagkunan: Kinuha mula sa Asian Health Services, www.ahschc.org.

HAndOuT—SESSIOn 9 349

Tips for Eating Out the Heart Healthy Way

You do not have to give up eating fast foods to eat right. Here are some tips on how to make heart healthy choices at fast food restaurants.

Sandwiches ♥ Order sandwiches without mayonnaise, tartar sauce, or special sauces. Or, try mustard or low-fat

mayonnaise. Ask for vegetables to be added to your sandwich.

♥ Order small, plain hamburgers instead of deluxe sandwiches. ♥ Order sandwiches made with lean roast beef or grilled chicken. Chicken and tuna salad made with

regular mayonnaise are high in fat.

♥ Choose grilled chicken or fish sandwiches instead of breaded chicken or fish sandwiches.

Main dishes ♥ Choose rotisserie-style chicken rather than fried chicken. Always remove the skin. ♥ Order pizza with vegetable toppings, such as peppers, mushrooms, or onions. Ask for half the

usual amount of cheese.

♥ Choose grilled, broiled, steamed, or baked fish instead of fried fish. ♥ Leave off sauces.

Side dishes ♥ Share a small order of french fries instead of eating a large order by yourself. ♥ Ask that no salt be added to your serving. ♥ Order a baked potato instead of french fries.

• Try vegetables as a potato topping.
• Ask that high-fat toppings, such as cheese or sour cream, be served

on the side, and use fewer toppings.

• Ask for low-fat cheese and low-fat sour cream. ♥ Use low-calorie, low-fat salad dressing on salad. Bring your own if the restaurant does not offer

a low-fat dressing. You can buy packets at some stores. Ask that dressings be served on the side, and use less.

♥ Order a green vegetable or salad instead of two or more starches, such as potatoes, steamed rice,

noodles (pasta), bread, and corn.

Beverages ♥ Choose water, 100% fruit juice, unsweetened iced tea, or fat-free or low-fat (1%) milk,

rather than a soft drink or a milkshake.

♥ If you really want to have a soft drink, order a small one or a diet soda.

Desserts ♥ Buy fresh fruits and gelatin instead of cakes or pies.

350 HAndOuT—SESSIOn 9

Mga Payo sa Pagkain sa Paraang Malusog sa Puso

Hindi mo kailangan isuko ang pagkain sa mga fast food upang kumain ng tama.

Narito ang ilang mga payo kung paano gumawa ng mga pagpipilian malusog sa puso sa mga fast food na restawran.

Mga Sandwich

♥ Umorder ng mga sandwich na walang mayonnaise, tartar sauce, o mga espesyal na

sawsawan. O, subukan ang mustard o low-fat mayonnaise. Humingi ng mga gulay na idadagdag sa iyong sandwich.

♥ Umorder ng maliit, mga hamburger na walang sahog sa halip na mga deluxe sandwich.

♥ Umorder ng mga sandwich na gawa sa walang taba na nilitson na baka o inihaw na

manok. Manok at tuna salad na ginawa na may regular mayonnaise ay mataas sa fat.

♥ Piliin ang inihaw na manok o mga fish sandwich sa halip na manok na may breading o

mga fish sandwich.

Pangunahing mga putahe

♥ Piliin ang manok na rotisserie-style kaysa sa pritong manok. Laging

alisin ang balat.

♥ Umorder ng pizza na may mga sahog na gulay, tulad ng mga pepper,

kabute, o sibuyas. Hilingin para sa kalahati para sa karaniwang dami ng keso.

♥ Piliin ang inihaw, nilitson, pinausukan, o hinurnong isda sa halip na pritong isda.

♥ Umiwas sa mga sarsa.

Mga side dish

♥ Mamahagi ng isang maliit na order ng french fries sa halip ng pagkain ng

isang malaking order sa pamamagitan ng iyong sarili.

♥ Hilingin na huwag dagdagan ng asin ang iyong takal.

HAndOuT—SESSIOn 9 351

Mga Payo sa Pagkain sa Paraang Malusog sa Puso (continued)

♥ Umorder ng isang hinurnong patatas sa halip na piniritong patatas.

• Subukan ang mga gulay bilang isang topping na patatas.
• Hilingin na ang mga high-fat na topping, tulad ng keso o sour cream, na maihain sa gilid, at gumamit ng mas kaunting mga topping.
• Humiling ng kesong low-fat at low-fat na sour cream.

♥ Gumamit ng low-calorie, low-fat salad dressing sa salad. Magdala ng iyong sariling

low-fat dressing kung ang restawran ay hindi nag-aalok nito. Maaari kang bumili ng mga naka-pakete sa ilang mga tindahan. Humiling ng mga dressing na ihahain sa gilid, at gumamit ng kaunti.

♥ Umorder ng isang berdeng gulay o salad sa halip ng dalawa o higit pang mga starch tulad

ng mga patatas, sinaing na kanin, noodles (pasta), tinapay, at mais.

Mga Inumin

♥ Pumili ng tubig, 100-porsyento na katas ng prutas, unsweetened iced tea, o

fat-free o low-fat (1%) na gatas kaysa sa isang soft drink o isang milkshake.

♥ Kung gusto mo talagang uminom ng soft drink, umorder ng isang maliit na

bahagi o isang diet na soda.

Mga Panghimagas

♥ Bumili ng mga sariwang mga prutas at gelatin sa halip na mga cake o pie.

352 HAndOuT—SESSIOn 9

(Optional) Eating Out With the de la Cruz Family Role Play

Ric has just arrived at his favorite Chinese restaurant buffet for a dinner with his mother, Lola Idad, and the family of his brother Cesar.

Cesar: This is a good restaurant. They have good food for good prices.

Ric: Eating at buffets is hard for me. I have been trying to eat healthy ever since the doctor told me that I have high blood pressure. But when I see and smell the food here, I want to try it all. It takes a lot of will power not to choose the fried foods, which have always been my favorite!

Cesar: Remember the advice that Jose gave you––choose the right foods, whether you are eating at home or eating out.

Lola: That’s right, Cesar. We can all make heart healthy choices, even when we eat out. Remember, “Kung may itinanim, may aanihin.” “If you plant, you will harvest.” If you follow a healthy lifestyle, you will improve your health. Make wiser choices and eat smaller portions, and you can lower your blood pressure and lose some weight—like I did!

Cesar: Ric, I am going to eat the steamed dumplings, vegetables, and rice with the baked fish. And I am only going to make one trip to the buffet table so I don’t eat too much.

Ric: That sounds like a good dinner. Cesar, let’s go to the buffet table together. I will follow your lead.

HAndOuT—SESSIOn 9 353

Money-Saving Tips

You can save money on groceries. Follow these simple suggestions.

Before Going to the Store

♥ Plan weekly meals. Your family can help you plan the menu.

♥ Make a shopping list based on your meal plan.

♥ Check the food sale ads.

♥ Use coupons. Check the Sunday newspaper, and clip coupons for foods you

normally buy or need. Ask your children or another family member to help you. Remember—coupons do not save you money if you buy products that you do not need. Always compare the price of the item using the coupon with the price of other items on the shelf.

♥ Make fresh foods at home instead of using prepared items such as frozen entrees, bakery cakes,

or salads.

Choosing a Store

♥ Shop at the store that has the lowest prices for the items you need. That may be a different store

every week.

♥ Remember that convenience stores tend to have higher prices and less variety than supermarkets.

At the Store

♥ Buy what is on your list. You are more likely to buy too much or buy items

that you do not need when you do not use a list.

♥ Convenience can cost more. Some examples include:

• Canned beans are high in sodium
• Boneless chicken breasts
• Precut vegetables ♥ Buy fruits and vegetables that are in season.

♥ Buy only the amount of food your family can use, even if a larger size costs less.

♥ Shop alone when possible. Family members or friends may try to get you to buy items you

do not need.

♥ Do not shop when you are hungry.

♥ Watch for errors at the cash register. Sometimes sale items do not ring up on sale. Some stores

give customers free items if they are charged the wrong amount.

354 HAndOuT—SESSIOn 9

Shopping List

Make a shopping list. Include the items you need for your menus and any basics you need to restock in your kitchen.

Produce Milk Products†

___ Fresh fruits (bananas, ___ Fat-free or low-fat (1%) milk apples, oranges, mangoes, ___ Fat-free or low-fat (1%) pineapple, papaya, grapes) cottage cheese ___ Fresh vegetables (cabbage, ___ Fat-free or low-fat cheeses bok choy, green onions, spinach, broccoli, carrots, ___ Fat-free or low-fat yogurt green onions, sweet ___ Light or diet tub margarine potatoes, peppers) ___ Fat-free sour cream ___ Garlic ___ Fat-free cream cheese

Whole-Grain Breads, ___ Eggs Muffins, and Rolls

___ Bread, bagels

___ English muffins

___ Pan de sal

___ Dinner rolls

Meats, Poultry, Fish,

and Seafood

___ Chicken

___ Fish (milkfish, grouper,

mackerel) ___ ____________________ ___ Seafood (shrimp, mussels, ___ ____________________ clams, crab, squid) ___ ____________________ ___ Beef (round or sirloin)

Cereals, Rice, Crackers, ___ Extra-lean ground beef and Noodles ___ Pork tenderloin, leg, shoulder

___ Steamed rice ___ Lower-fat lunch meats (chicken, lean roast beef)* ___ Noodles (pasta) ___ Tofu ___ Cereal, dry or cooked ___ Dry beans and peas ___ Other _______________ ___ Unsalted roasted nuts ___ Soda crackers* ___ Peanut butter* ___ Graham crackers ___ Other crackers*

Baking Items

___ ____________________ ___ Flour ___ ____________________ ___ Sugar ___ ____________________ ___ Vegetable oil spray ___ Fat-free canned evaporated milk ___ Fat-free dry milk powder ___ Unsweetened cocoa powder ___ Baking powder

Canned Fruits, Vegetables, Beans, and Soups

___ Canned fruit in juice ___ Applesauce ___ Canned tomatoes (no salt added) ___ Low-sodium tomato sauce or paste ___ Other canned vegetables (no salt added) ___ Canned broth (fat-free, low-sodium)* ___ Other canned soups* ___ Canned beans or peas (no salt or seasoning added) ___ _____________________ ___ _____________________

Fats and Oils

___ Margarine (liquid, tub, or diet)* ___ Unsaturated vegetable oil

Frozen

___ Fat-free or low-fat frozen yogurt and desserts* ___ Frozen vegetables without sauces ___ Frozen fruit juices

Other

___ Herbs and spices (anise, basil, bay leaf, lemongrass, oregano, parsley, saffron, sage) ___ Vinegar ___ Light soy sauce (low sodium)

fat, cholesterol, sodium, and calories. † Or lactose-free milk and milk products, such as low-fat or fat-free soy milk.

HAndOuT—SESSIOn 9

Healthy foods do not have to be expensive! Compare these two shopping lists. Which list has healthier food choices? Which list has the best buys?

List #1

Food

1 large bag (20 oz.) potato chips

2-liter bottle, cola

1 small bag (2.5 oz.) beef jerky

1 ensaymada (sweet bread)

1 chocolate candy bar

Total Cost

List #2

Cost* Food Cost*

grapes

Make smart choices: Save money, and eat heart healthy!

• Costs based on prices in the metropolitan Washington, DC, area.

Source: Adapted from the HHS Office on Women’s Health, U.S. Department of Health and Human Services,

BodyWorks Toolkit.

HAndOuT—SESSIOn 9

Kare-Kare (Peanut Stew) Recipe

9 ounces (250 grams) 1 2 cloves 2 tablespoons ½ cup ¼ cup ¼ teaspoon 3.5 ounces (100 grams) 7 ounces (200 grams) 5 ounces (150 grams) 3.5 ounces (100 grams)

gluten or seitan,* cubes onion, medium, sliced garlic, crushed corn oil ground peanuts ground toasted rice† salt string beans, sliced eggplant, sliced banana heart or bud bok choy (pechay), sliced

• Gluten is made from protein that is in a variety of grains, such

1. Saute gluten cubes in

corn oil. Add garlic and onions.

1. Pour enough water to

cover gluten, and add ground peanuts and ground rice to thicken.

1. Add atsuete for coloring,

and season with salt.

1. Add the eggplant, then

string beans, then banana, then bok choy (pechay).

1. Place on top of the cooked

gluten.

as wheat and rye, and is mixed with water and kneaded. A form of wheat gluten, seitan, goes through the process and is sold as strips or in cans at health food stores and Asian supermarkets.

cup at a time, in a frying pan or wok and heat over moderate heat, stirring frequently to keep it from burning and to allow it to develop a uniform, deep golden color—2 to 3 minutes. Then remove it from heat and cool to room temperature. Grind the toasted rice coarsely—not finely grounded—in a blender, or spice or coffee grinder.

Quick Facts

This version of vegetable kare-kare is healthier than the traditional Filipino dish because:

• It does not contain cholesterol because it uses the protein product gluten instead of oxtails or other meat.
• It includes a lot of vegetables and fruit.
• The rich, nutty sauce has only a small amount of sodium.

Yield: Serving size 6 servings Calories 300 kcal Total Fat 12 g Saturated Fat 1.5 g Cholesterol 0 mg Sodium 125 mg Total Fiber 4 g Protein 36 g Carbohydrates 20 g Potassium 320 mg

Division of Nutrition and Dietetics, Philippine Heart Center, East Avenue, Quezon City, Philippines, page 91.

HAndOuT—SESSIOn 9

Lola’s Life Lessons: Session 9

One of my favorite proverbs is:

“Ang taong matalino ay hindi tumitingin sa pagyapak ng paa niya sa lupa. Binabantayan niya ang kanyang kasunod na hakbang.”

Translation: “A wise man does not see his foot on the ground; he watches his next step.”

Your future includes balancing your health, your time, and your money. Be wise in your future choices. When I learned that I have high blood pressure, your Lola had to make changes in her lifestyle to lower her blood pressure and to keep good heart health. Heart healthy eating is possible on a busy schedule and on a budget, but you need to be wise and plan ahead.

Look at Rose. With help from Mila, she has learned to be heart smart about cooking. Rose now prepares dishes on the weekends and stores them in the freezer. She uses a list to go shopping and plans her family’s meals ahead of time. This helps her know what to buy at the grocery store. Rose also has been buying fewer foods that are high in fat and sodium, and her family is not eating out as often. Sometimes, Mila and I will cook extra food to share with Rose to make sure the family stays heart healthy.

To make it work, you have to think ahead. Keep your heart and family in mind when planning the family’s meals and when planning the next step.

A Time To Reflect…

When there is little time or money, what can you do to keep your family heart healthy?

(Use this space to write down your thoughts for this week’s session.)

358 HAndOuT—SESSIOn 9

Pledge for Life! Session 9

Take the pledge for life with Lola Idad. Try to do one of these activities by yourself and/or share with others.

Use a slow cooker (Crock-Pot®) for quick and easy cooking.

Cook several dishes at one time, and freeze part of them.

Order smaller portion sizes instead of larger portion sizes.

Choose heart healthy foods and smaller portion sizes if you choose to eat at a buffet.

Choose prepared foods at the grocery store less often.

If the serving size is too big at the restaurant, bring home leftovers.

Choose baked, steamed, broiled, or grilled dishes instead of fried.

Order less meat and more vegetable dishes.

Try not to shop at convenience stores.

Go to the market when you are not hungry.

Plan weekly meals, and shop with a list.

Try a store-brand product to save money.

Other

HAndOuT—SESSIOn 9 359

s essi o n

Take Control of Your Health: Enjoy Living Smoke Free

Objectives

By the end of this session, group members will learn:

• How cigarette smoking harms smokers
• How secondhand smoke harms people who are near smokers
• Tips that can help smokers who want to quit
• Ways to ask people not to smoke around you

Materials and Supplies

To conduct this session, you will need:

• “Healthy Heart, Healthy Family” manual and picture cards
• Blackboard and chalk or several large pieces of paper, markers, and tape

Handouts

Give group members these handouts during the session:

• List of places where smoking cessation programs are offered*

________

• Prepare this list before the session. You may find information at your local health department, hospital, or a clinic.

Session 10. Take Control of Your Health: Enjoy Living Smoke Free 361

• (Optional) “A Smoke-Free Life Role Play” (page 381)
• “Smoking Harms You” (page 382)
• “Smoking Harms Infants and Children” (page 383)
• “Costs of Smoking” (page 384)
• “Role Play: Someone Is Smoking. What Can You Do?” (pages 385–387)
• “Smoke-Free Family Sign” (pages 388–389)
• “Tips To Quit Smoking” (pages 390–393)
• “Help Your Heart—Don't Smoke” (page 394)
• “Break Free From the Smoking Habit” (pages 395–397)
• “Lola’s Life Lessons” (page 398)
• “Pledge for Life!” (page 399)

Note: Posters and other materials may be ordered from the following organizations:

• National Cancer Institute—1–800–4–CANCER (1–800–422–6237) or

www.cancer.gov/

• American Lung Association—1–800–LUNGUSA (1–800–586–4872) or

www.lungusa.org

• American Cancer Society—1–800–ACS–2345 (1–800–227–2345) or

www.cancer.org

• American Heart Association—1–800–AHA–USA–1 (1–800–242–8721) or

www.americanheart.org

362 Healthy Heart, Healthy Family: A Community Health Worker’s Manual for the Filipino Community

Session Outline

Introducing the Session

1. Welcome
2. Review of Last Week’s Session
3. About This Session

Conducting the Session

1. (Optional) “A Smoke-Free Life” Role Play
2. Facts About Smoking
3. Smoking Harms Infants and Children
4. Youth and Smoking
5. Smoking and Your Wallet
6. Secondhand Smoke

A. Secondhand Smoke Can Harm You and Those Around You

B. Secondhand Smoke Role-Playing Activity

1. Quitting Smoking

Review of Today’s Key Points

Lola’s Life Lessons: A Time To Reflect

Pledge for Life!

Closing

Session 10. Take Control of Your Health: Enjoy Living Smoke Free 363

Introducing the Session

1. Welcome

• Welcome group members to the session.

2. Review of Last Week’s Session

At the last session, we talked about ways to save money on our food bills. Who can name some of them?

Note: Write group members’ ideas on the blackboard or on a large piece of paper taped to the wall.

• Add these ideas if they are not mentioned:

• Plan weekly meals, and shop with a list.

• Clip coupons for products you use.

• Check the food sale ads.

• Use fewer prepared foods.

• Buy only the amount of food your family needs.

• Shop alone, when possible.

• Try not to shop when you are hungry.

• Check your receipt for errors at the register.

• Shop at convenience stores less often.

• Use store brands as often as possible.

364 Healthy Heart, Healthy Family: A Community Health Worker’s Manual for the Filipino Community

• Ask:

How are you doing with your pledges to eat in a heart healthy way even when time or money is tight? What went well? Did you have problems? If so, what did you do to solve them?

Note: Allow 5 to 8 minutes for group members to respond.

3. About This Session

This session is about the importance of not starting to smoke and quitting smoking. During this session, you will learn:

• How cigarette smoking harms smokers

• How secondhand smoke can harm you or those around you

• Ways to ask people not to smoke around you

• Tips to quit smoking (for you and others)

This session is about the dangers of smoking to heart health. Lola Idad knows the dangers of smoking well. She saw her husband struggle with his smoking habit until his last days. Lola often reflects on the Visayan proverb, “Walang tagumpay, kung walang paghihirap.” “There is no success if there is no sacrifice.”

• Ask:

• How many of you smoke?

• How many of you live with a smoker?

• How many of you would like to live smoke free?

Tobacco is used in a variety of ways—in cigarettes, cigars, pipes, and chewing tobacco. This session focuses on cigarette smoking, because it’s the most common use of tobacco.

Session 10. Take Control of Your Health: Enjoy Living Smoke Free 365

Note: Other names for cigarettes include “yosi,” “smokes,” “cigs,” and “butts.”

Conducting the Session

1. (Optional) “A Smoke-Free Life” Role Play

• Give each group member the “A Smoke-Free Life Role Play” handout (page 381). Ask for two volunteers to be actors for the role play. Select a third volunteer to be the narrator.

Note: Allow 5 minutes for open discussion.

• Ask:

• What are some of the lessons we learned from this role play?

• Is there any part of the play that you can use in your own life?

2. Facts About Smoking

About 15 percent of Filipino adults and 7 percent of Filipino adolescents (age 12 to 17 years) in the United States smoke cigarettes.

There are many reasons why you should quit smoking or not start smoking. Let’s go over these reasons:

• In the United States, about 440,000 people die each year from diseases

related to smoking. This is more than 1,200 people each day. Smoking causes about one in every five deaths.

• Health care costs due to smoking are about $75 billion each year in the

United States.

366 Healthy Heart, Healthy Family: A Community Health Worker’s Manual for the Filipino Community

• Smokers use tobacco regularly because they become addicted to nicotine,

which is a powerful drug. Nicotine is found in all tobacco products. Most cigarettes contain 10 milligrams (mg) or more of nicotine. By inhaling the smoke, the average smoker takes in 1 to 2 milligrams of nicotine per cigarette.

• Smoking can harm those around you! Cigarette smoking puts the health of

your family, children, and friends at risk.

• Show picture card 10.1.

Today, we are going to talk about what can happen when you smoke. We also are going to talk about ways to stop smoking and ways to support a friend or family member who wants to quit.

• Give group members the “Smoking Harms You” handout (page 382), and review the information.

Note: Ask for volunteers to read the handout aloud. Keep the picture card on display while you review this handout.

3. Smoking Harms Infants and Children

• Show picture card 10.2.
• Ask:

Do you think it is all right for pregnant women to smoke?

Note: Allow a moment for group members to respond.

Pregnant women should not smoke, because it will affect their babies’ health and well-being. They should also stay away from others who smoke, because of the harm that secondhand smoke causes.

Let’s go over some problems that can arise when pregnant women smoke.

Session 10. Take Control of Your Health: Enjoy Living Smoke Free 367

• Give group members the “Smoking Harms Infants and Children” handout (page 383).

Note: Ask for volunteers to read the handout aloud, or you can cut out the facts, following the dotted lines on the handout, and put them in a box. Let group members draw slips of paper and read the facts aloud. Keep picture card 10.2 on display while you review the handout.

4. Youth and Smoking

• Show picture card 10.3.
• Ask:

Why do you think many people begin smoking as teenagers?

Note: Review the picture card to show the reasons that teens smoke.

• Add the following reasons if they are not mentioned:

• Teens want to be like their friends.

• Young people smoke to try to look older.

• Some teens want to be like celebrities who smoke in movies or on television.

• Some teens are influenced by advertisements that make smoking look “cool”

or glamorous.

• Some teens may want to be like their parents or other family members

who smoke.

• Some teens will smoke just to do something their parents don’t want them

to do.

• Young people downplay the harm smoking can do, or they think they will

not be harmed.

• Teens may like the jackets, hats, and other prizes that tobacco

companies offer.

368 Healthy Heart, Healthy Family: A Community Health Worker’s Manual for the Filipino Community

Let’s look at some of the facts about young people and smoking.

• Each day about 2,000 young people under age 18 become regular

smokers. That’s nearly 750,000 teens per year. If this continues, more than 6 million young people who are regular smokers could die from a tobaccorelated disease.

• Young people who use tobacco may find it hard to play sports. Smoking

causes shortness of breath and dizziness. Chewing tobacco causes dehydration.