Welcome To The Med-South Lifestyle Program
Welcome to theMed-SouthLifestyle ProgramThis program can help you improve what you eat and help you become more physically active.Eating in a healthy way and being physically active can reduce the risk of heart disease, stroke,and getting diabetes and can improve outcomes for those who have these conditions. It is calledthe Med-South Lifestyle Program because the eating plan is similar to a Mediterranean diet andthis program was originally developed for use in the southeastern United States. This type ofeating pattern has been shown to lower the risk of heart attack and stroke by nearly 30% and therisk of getting diabetes by about 50%.The program is designed to be given during 4 sessions. A health coach will lead you throughone session each month. There is also an option to check in with your coach between sessions toreview your progress. The content of each program session and a list of additional materials isshown in the Table of Contents. The content of this program was revised on March 1, 2017 to becurrent with the scientific literature on healthy eating, physical activity, and health outcomes.i
AcknowledgementsOver the years, many individuals have contributed to prior versions of the materials used in thismanual. The primary authors of this version are: Thomas Keyserling, MD, MPH, Professor of Medicine, UNC-Chapel Hill Alice Ammerman, DrPH, RD, Professor of Nutrition, UNC-Chapel Hill Carmen Samuel-Hodge, PhD, MPH, RD, Research Assistant Professor, UNC-Chapel Hill Stephanie Jilcott Pitts, PhD, Associate Professor of Public Health, East Carolina University Kelly Evenson, PhD, Research Professor of Epidemiology, UNC-Chapel Hill Beverly Garcia, MPH, UNC Center for Health Promotion and Disease Prevention Larry Johnston, MA, UNC Center for Health Promotion and Disease Prevention Larissa Calancie, PhD, Postdoctoral Fellow, Center for Health Equity Research, Department ofSocial Medicine, UNC-Chapel HillGraphic Design and ProductionPeople DesignsUNC Printing ServicesAdditional ThanksWe gratefully acknowledge the use of materials adapted from A New Leaf Choices for HealthyLiving (available at www.center-trt.org).Supported by funding from:Grant Number 5P50HL105184 from the National Institutes of Health, National Heart, Lung, andBlood InstituteCooperative Agreement Number 1U48DP002658 from the Centers for Disease Control andPrevention, Prevention Research Center Program The University of North Carolina at Chapel Hill 2017 Center for Health Promotion andDisease Preventionii
Table of ContentsSession 1:A Healthy Eating PlanIntroduction.1Nuts, Oils, Dressings, and SpreadsHow are you doing?.7Background information.9Tips.13Goals.15Session 2:Check-in on Progress with Session 1 GoalsVegetables, Fruit, Whole Grains, and BeansHow are you doing?.19Background information.21Tips.25Goals.30Introduction to Physical ActivityHow are you doing?.35Introduction.39Background information.43Tips.47Goals.49Continued iii
Table of ContentsSession 3:Check-in on Progress with Session 2 GoalsDrinks, Desserts, Snacks, Eating Out, and SaltHow are you doing?.53Background information.55Tips.62Goals.64Other Types of Physical ActivityHow are you doing?.68Background information.71Tips.75Goals.77Session 4:Check-in on Progress with Session 3 GoalsFish, Meat, Poultry, Dairy, and EggsHow are you doing?.81Background information.83Tips.87Goals.89Staying Physically ActiveHow are you doing?.93Background information.95Tips.96Goals.101Continued iv
Table of ContentsAdditional Materials for Healthy EatingBe Serving Size Wise.105Best Oils for Cooking and Frying.107Cooking for One or On the Run.109Read the Label.111Eating Healthy on a Budget.113A Shopping List to Improve Fat Quality.115Additional Materials for Physical ActivityChair Exercises for Strength and Flexibility.119v
A Healthy LifestyleSession 1Introduction
IntroductionA HealthyEating PlanHow Can Healthy Eating Improve Your Health?Healthy eating can improve your health in many ways. It helps to:ÛÛ Prevent many health problems, such as heart disease, stroke, high blood pressure, and diabetes.ÛÛ Control health problems, such as high blood pressure, high cholesterol, or diabetes.ÛÛ Manage weight.ÛÛ Have a positive impact on those you love, such as your children, parents, and friends, by helping themchoose more healthy foods.Many people also say healthy eating helps them look and feel better.What Is Different about This Healthy Eating Program?This study is based on current research about what is healthy to eat. The advice given by this programmight be different from what you have heard before about healthy eating. We think you will enjoy thenewer approaches to healthy eating that are given by this program.The Major Difference with This Program Is:ÛÛ A focus on fat quality and not the amount of fat in your diet. Depending on what you eat now, thisprogram may suggest an increase in healthy fats, such as those in vegetable oils, nuts, and fish. Eatingmore high-quality fat opens up many possibilities for healthful and tasty eating.This Program Will alsoFocus on:ÛÛ Increasing vegetables, fruits, andwhole grains since these are allimportant to a healthy eating pattern.ÛÛ Substituting other foods or beveragesfor those that are not healthy. Forexample, we offer many tips onhealthy beverages that are muchbetter for you than regular soda orvery sweet iced tea. 2017 UNC-CH Center for Health Promotion and Disease PreventionA Healthy Eating Plan1
A HealthyEating PlanIntroductionGetting Started on a Healthy Eating Plan for LifeIn addition to learning what to eat, many people needhelp making a plan to get started. Here are some things tokeep in mind as you start making changes to your eatinghabits:ÛÛ Find something that works for you. People are morelikely to stick with an eating plan if it fits with theirlifestyle and budget.ÛÛ Pick foods that you like to eat. In general, people aremore likely to stick with an eating plan that they like.ÛÛ Make small changes first. Making small changes oneat a time is easier than changing everything at once.Taking small steps makes change easier.ÛÛ Plan ahead. It takes planning to stick with a healthyeating plan. This means planning so that you havehealthy food on hand when you are hungry orpreparing meals. Plan what healthy choices you willmake when you go out to eat at restaurants.ÛÛ Don’t give up. Everyone gets off track now and then;don’t be too hard on yourself. The important part isthat you pick up and start right where you left off assoon as possible.Physical Activity Is Also VeryImportant for Your HealthLike healthy eating, being physically activecan also reduce the risk for many chronichealth problems and help manage healthproblems like high blood pressure anddiabetes. Most experts recommend 30minutes of moderate intensity activity, likea brisk walk, on most days of the week.2A Healthy Eating Plan 2017 UNC-CH Center for Health Promotion and Disease Prevention
IntroductionA HealthyEating PlanHow the Healthy Eating Program WorksThe program is given in four sessions with different foods covered in each session.Session 1: Nuts, Spreads, Dressings, and OilsSession 2: Vegetables, Fruit, Whole Grains, and BeansSession 3: Drinks, Desserts, Snacks, Eating Out, and SaltSession 4: Fish, Meat, Poultry, Dairy, and EggsStarting with Session 2, we also provide information on being physically active.The Format for Each Session Is SimilarÛÛ Each session covers different types of foods and begins with questions for you to answer about thesetypes of foods. In Sessions 2-4, there are also questions about your physical activity.ÛÛ Then, background information is provided about the foods covered in the session and physical activity(Sessions 2-4).ÛÛ Next is the tip section, where you select goals to work on to improve your health.ÛÛ Last is the goal sheet, with first steps toward achieving your goals and a table for checkingyour progress. 2017 UNC-CH Center for Health Promotion and Disease PreventionA Healthy Eating Plan3
Nuts, Oils, Dressings,and SpreadsSession 1AsssessmentBackground InformationTipsGoals
Assessment ofCurrent Eating HabitsNuts, Oils,Dressings,and SpreadsÛÛ Are you allergic to tree nuts (like almonds, pecans, walnuts, or cashews)?YesNoÛÛ Are you allergic to peanuts?YesNoÛÛ Are you allergic to both?YesNoDesirableCould beimproved1. How many servings of peanut butter, other nutbutters, or nuts (like peanuts, almonds, pecans,walnuts or cashews) do you usually eat? 3 2 0-12. What type of butter or margarine do youusually use? transfat-freemargarine(most tubmargarinesare transfat-free) butter stickmargarine3. Eat foods fried, sautéed, or baked at home usingvegetable oil (olive, soybean, canola, or corn oilor tub/liquid margarine)? 3 1-2 04. Use regular (full-fat) salad dressing (Do NOTinclude no-fat, fat-free, and low-fat dressings)? 3 1-2 05. Use regular mayonnaise (Do NOT includeno-fat, fat-free, and low-fat mayonnaise) onsandwiches or in tuna, chicken, or egg salad oruse regular (full-fat) tartar sauce? 3 1-2 0In an average WEEK,Needs tobe improvedIn an average WEEK, how many times do you 2017 UNC-CH Center for Health Promotion and Disease PreventionNuts, Oils, Dressings, and Spreads7
Background InformationNuts, Oils,Dressings,and SpreadsEating FatsThere are three types of fat we’ll focus on in this program:ÛÛ Polyunsaturated and monounsaturated fats: These are healthy fats and arefound in vegetable oils, nuts, some dressings and spreads, and fish.ÛÛ Trans fats: These are unhealthy fats and are found in most stick margarine andshortening, some baked goods, some packaged snack foods, and fried foodsfrom some restaurants.EatNutsOftenÛÛ Saturated fats: These are found in beef, pork, dairy products, and are high insome vegetable oils.What Do We Mean by Healthy Fat?Healthy fats mostly come from plants or fish.Healthy fats can be found in the following oils and foods:ÛÛ Nuts (like peanuts, pecans, walnuts, and almonds) andnut butters.ÛÛ Vegetable oils, like canola, soybean, olive, peanut, andcorn oils. Extra virgin olive oil may have additionalhealth benefits compared to other oils.ÛÛ Salad dressings, mayonnaise, and other spreads madewith the healthy vegetable oils listed above.ÛÛ Fish, such as tuna, herring, salmon, and lake trout.ÛÛ Trans fat-free margarine spread (generally in soft or tub form).How Much Healthy Fat Do I Need Each Day?Two to six servings each day is a good goal. Serving sizes for common foods that contain healthy fat are:ÛÛ Nuts: a small handful (one ounce or 30 grams) or two tablespoons of nut butterÛÛ Regular mayonnaise (full-fat): one tablespoonÛÛ Fish: three ounces (about a deck of cards)ÛÛ Avocado: one quarterÛÛ Regular salad dressing (full-fat): one to two tablespoons 2017 UNC-CH Center for Health Promotion and Disease PreventionNuts, Oils, Dressings, and Spreads9
Nuts, Oils,Dressings,and SpreadsBackground InformationThere Are Many Ways to Fit Heart Healthy Fats Into Your Eating PlanEat Nuts and NutButters OftenNuts are a great source of healthyfats. Many studies have shownthat people who eat nuts are lesslikely to get heart disease. Eatnuts or nut butters three or moretimes a week.Use Healthy OilsHealthy oils include: canola,soybean, olive, peanut, andcorn oil. Also, many storessell “vegetable oil,” which is acombination of different oils.To eat more healthy oils:ÛÛ Use healthy oils often when you are cooking, sautéing, and frying.ÛÛ Cut down on the cost of expensive oils, like olive oil, by using it for dipping bread and in salad dressings.Use less expensive oils for cooking, sautéing, and frying.Use Healthy SaladDressingsMany people think low- or no-fat saladdressings are good for your health. Infact, regular (full-fat) salad dressingscontain healthy oils and are better foryour health. Also, low-fat and no-fatdressings may contain more salt andsugar than regular dressings. So, eatsalad often and enjoy full-fat saladdressings.10Nuts, Oils, Dressings, and Spreads 2017 UNC-CH Center for Health Promotion and Disease Prevention
Background InformationNuts, Oils,Dressings,and SpreadsUse Healthy SpreadsHealthy spreads (such as those you put on your bread or use insandwiches) are a good source of heart healthy fats.To choose healthy spreads:ÛÛ Use trans fat-free margarines. These are made from vegetableoils and are a good choice for spreads and for cooking. Mostare in tub form.ÛÛ Use regular (full-fat) mayonnaise (not the reduced-fat or nofat kind) for sandwiches. Mayonnaise is made with healthyvegetable oils (usually soybean or canola oil).ÛÛ Use regular (full-fat) tartar sauce, which is also made withhealthy vegetable oils.What Are Unhealthy Fats?Unhealthy fats (trans fats) are made when liquid vegetable oils are turned into solid fats for margarine orshortening. Some deep-fat frying oils are also high in trans fats. Eating trans fats increase the risk of heartdisease.Trans fats can be found in the following foods:ÛÛ Stick margarineÛÛ Most shorteningÛÛ Some store-bought baked goods andpackaged snack foodsÛÛ Some fried foods and biscuits fromrestaurants, though many restaurantsare working to lower the trans fats intheir foodsBecause trans fats increase the risk ofheart disease, it is important to eat aslittle trans fat as possible. 2017 UNC-CH Center for Health Promotion and Disease PreventionNuts, Oils, Dressings, and Spreads11
Nuts, Oils,Dressings,and SpreadsWhat about Saturated Fats?In the past, experts thought saturated fat increased the risk forheart disease. However, recent studies suggest saturated fatsdo not increase heart disease risk. Even though these fats donot increase the risk for heart disease, they don’t decrease iteither. The foods that lower your risk of heart disease includehealthy fats, and other foods like vegetables and fruits, andwhole grains.Foods high in saturated fats include:ÛÛ Dairy products (except skim and very low-fat dairyproducts) including cheese, butter and creamÛÛ LardÛÛ “Tropical vegetable oil,” including palm and coconut oilBackground InformationSummaryHere is a summary of key pointsabout Nuts, Oils, Dressings, andSpreads.ÂÂ To reduce heart disease risk,it is important to eat healthyfats on a daily basis.ÂÂ Eat nuts and nut buttersoften – at least 3 times aweek.ÂÂ Eat foods made with healthyvegetables oils daily.ÛÛ Red meat, including beef, pork and lamb.NOTE: Unlike some of the other foods high in saturated fats, eating red meat increases the risk ofheart disease a modest amount, and eating processed meats (bacon, sausage, hot dogs, bologna, anddeli meats like roast beef, turkey, and ham) increases the risk of heart disease more than regular meat.Also, people who eat large amounts of red meat are at higher risk of getting colon cancer. This is whywe recommend 0-1 serving of red meat each day.How Often Should I Eat Foods with High Amounts of Saturated Fats?It is fine to eat foods with some saturated fat (though red meats should be limited) as long as you also eatthe healthy foods suggested by this program. In other words, there needs to be “room in your eating plan”to eat healthy fats, fruits and vegetables, and whole grains each day.Won’t Eating More Fat Cause Meto Gain Weight?Many people think eating foods high in fats causesweight gain. We now know eating patterns that arehigher in fat do not cause weight gain. And becausefoods with healthy fats reduce the risk of heartdisease and stroke, it is important to eat thesefoods often.12Nuts, Oils, Dressings, and Spreads 2017 UNC-CH Cen
the Med-South Lifestyle Program because the eating plan is similar to a Mediterranean diet and this program was originally developed for use in the southeastern United States. This type of eating pattern has been shown to lower the risk of heart attack and stroke by nearly 30% and the risk of getting diabetes by about 50%.
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