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

Manual Contents

Session 6
Keep The Beat: Aim for a Healthy Weight

Page Contents

Objectives

By the end of this session, group members will:

  • 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.

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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) - 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.
  • (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

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Handouts

Give each group member these handouts during this session:

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Introducing the Session

  1. Welcome
  2. Review of Last Week's Session
  3. About This Session
  1. Welcome
    • Welcome group members to the session.
  2. Review of Last Week’s Session
    • Say:
      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?
      Note: Allow 5 minutes for group members to respond.
  3. About This Session
    • Say:
      Today, we will discuss why keeping a healthy weight is important to heart health.
    • Say:
      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.
    • Say:
      You will also find out if you need to lose weight by learning your body mass index (BMI) and your waist measure.
    • Say:
      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.

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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
  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
    • Say:
      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.
    • Say:
      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.
    • Say:
      Losing a small amount of weight can improve many health problems that come from being overweight.
  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.
    • Say:
      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.
    • Say:
      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.
    • Say:
      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.
    • Say:
      Let’s use the BMI chart on the handout that I gave you to find out if Cesar and Mila have healthy weights.
    • Say:
      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.
    • Say:
      Cesar’s BMI is 28, so he is overweight. Mila’s BMI is 24, so she is at a healthy weight.
    • Say:
      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.
    • Say:
      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.
    • Say:
      The first step is to find out our BMI, using the chart on the handout that I gave you. We will follow the same process that we used with Cesar and Mila.
    • Say:
      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.
    • Say:
      Please raise your hand if you are having trouble, and I will help you.
    • Say:
      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 35 inches (88 centimeters) for women and 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 group members’ waists, their waist measures are high.

    • Say:
      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.
    • Say:
      In the third step, we will find out if you need to lose weight. Look at your BMI and waist measure.
    • Say:
      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 triglycerides
      • High blood glucose
      • Family history of heart disease
      • Not being physically active
      • Smoking
    • Say:
      Let’s review the risk factors.
    • Ask:
      How many of these factors do you have?
      Note: Allow a moment for group members to think about their answers to this question.
    • Say:
      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.
    • Say:
      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.
      • 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: Have two or more risk factors, or 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
    • Say:
      Let’s talk about the healthy way to lose weight.
    • Say:
      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.
    • Say:
      If you need to lose weight, you must choose foods with fewer calories or become more physically active. It’s best to do both.
    • Say:
      To lose weight, you must burn more calories than the calories you eat.
    • Say:
      Pregnant women should not try to lose weight.
    • Give group members the “Commit to Losing Weight: Make Long-Term Changes!” handout and “Lola’s Habits and Her Weight” handout.
    • Say:
      Please review the “Commit to Losing Weight: Make Long-Term Changes” handout to find out how Lola found success managing her weight.
    • Say:
      The “Lola’s 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.
    • Say:
      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.
    • Say:
      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.
    • Give group members the “Lola’s Tips To Help You Control Your Weight” handout. 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 experience 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.
      • 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 the 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.
    • Say:
      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.
    • Say:
      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.
    • Say:
      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.
    • 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
    • Say:
      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.

      Before the session

      1. Check the “Serving Sizes” handout 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. Ask volunteers to read aloud the serving sizes for each. Tell them to use this handout at home.
  8. Nutrition Facts Label Activity – Calories
    • Note: This activity will help group members choose foods that are lower in calories.
    • Say:
      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.
    • Say:
      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 Food Label for Calories!” handout.
    • Say:
      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.
    • Say:
      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.
    • Say:
      “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

      • Reduced-fat chocolate chip cookies, 3 cookies (30 grams) = 118 calories
      • Baked tortilla chips, 1 ounce = 113 calories

      Calories in regular-fat food

      • Regular chocolate chip cookies, 3 cookies (30 grams) = 142 calories
      • Fried tortilla chips, 1 ounce = 143 calories
    • Say:
      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. Read “Lola’s Family Eats Healthier Snacks”. Ask group members which foods Lola should serve.

      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 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.
  9. Lumpiang Sariwa (Fresh Lumpia) Recipe
    • Give group members the “Lumpiang Sariwa (Fresh Lumpia) Recipe” handout.
    • Say:
      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!

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Review of Today's Key Points

  • Say:
    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.

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Lola's Life Lessons: A Time To Reflect

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

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Pledge for Life!

  • Say:
    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.
  • Say:
    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.
    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.
  • Say:
    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.

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Closing

  • Say:
    Thank you for coming today. What did you think of today’s session?
    Note: Allow a moment for group members to respond.
  • Say:
    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?

Go to Session 5

Go to Session 7


Information on this page is taken from the English print version of “Healthy Heart, Healthy Family: A Community Health Worker's Manual.” U.S. Department of Health and Human Services, National Institutes of Health, National Heart Lung and Blood Institute, NIH Publication No. 08-3674, Originally Printed 1999, Revised May 2008.

Last Updated March 2012

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