Page 53 - Nutrition Counseling and Education Skills: A Guide for Professionals

The professional interviews a client.

The client’s estimation of portion size is important. To overcome the problem of judging portion sizes,
counselors may display three-dimensional food models, food pictures, serving utensils, dishes, measuring cups
and spoons, and various sizes of beverage glasses. An 8-ounce glass is small, for example, compared with the
large servings at convenience stores and fast-food restaurants.

CASE ANALYSIS 2

What questions would you ask Mrs. Maynard about food shopping and meal preparation?

The perception that large portions are appropriate to eat is called portion distortion. Consumers may have
difficulty recognizing portions appropriate for their weight and activity level. Amorphous portions of foods
such as potato chips, French fries, mashed potato, and popcorn may be difficult to visualize as are small
portions such as spreads. A deck of cards, a baseball, or pieces of foam of various sizes can assist visualization.
A selection of actual food packages, snack wrappers, food labels, and other resources may also be helpful.

Some reports indicate that clients may not volunteer information about foods they think others find less
desirable. Examples of sensitive topics may include candy, desserts, alcoholic beverages, certain snacks, butter
or margarine, take-out foods, binge eating, and others.6 Underreporting of food intake is frequent. The client
decides how sensitive the information is and what to provide.

New and future technologies when fully validated will improve practice as well as research. Self-reports of
dietary intakes attained during interviews or keeping food records for 1 to 7 days are used. One study
combined dietary recalls with pre- and postmeal digital photographs.14 Innovations with mobile telephones
capturing snacks and meals images and the use of wearable cameras provide image-based dietary records.15
Image-assisted dietary assessments provide additional information.

Digital cameras, photographing meals and snacks, wearable cameras, and smartphones can record images of
foods eaten. These supplement client data showing foods eaten, and portion sizes.15–17 Wearable cameras have
increased the accuracy of self-reports by showing unreported foods, such as snacks.18 Using wearable cameras
for 4 days when consuming food showed eating locations, portions, watching television, and environmental
and social interactions.19

Digital camera photography was used to assess food intakes of adults and children using images of the foods
selected and the plate waste as compared with standard portion sizes. In another study using a remote
method, participants gathered information using apps downloaded to their smartphones. To estimate food
intakes, they captured images of foods and leftovers which were sent wirelessly for analysis. Work will
continue to improve on this method.20

Computer-administered FFQs or 24-hour recalls were found to improve the accuracy of paper-
administered questionnaires. Recent technological and web-based methods for improving assessment in
surveys and research are being used.6 Other techniques are being tested.

To save time, a short dietary assessment using a diet history and/or FFQ can be narrowed to focus only on
the person’s health problem, such as emphasizing dietary sources of fat in heart disease, foods high in sodium
in hypertension, or calcium and vitamin D in osteoporosis. One example is the MEDFICTS (Meats, Eggs,

53