With Every Heartbeat Is Life:  A Community Health Worker's Manual for African Americans

Session 5
Be Heart Smart: Keep Your Cholesterol in Check

Contents

• Introduction
• Session 1 — Knowledge Is Power: Know Your Risk for Heart Disease
• Session 2 — Act in Time to Heart Attack Signs
• Session 3 — Get Energized! Say YES to Physical Activity
• Session 4 — Help Your Heart: Control Your High Blood Pressure
• Session 5 — Be Heart Smart: Keep Your Cholesterol in Check
• Session 6 — Embrace Your Health! Aim for a Healthy Weight
• Session 7 — Protect Your Heart: Take Good Care of Your Diabetes for Life
• Session 8 — Make Heart Healthy Eating an Everyday Family Reunion
• Session 9 — Eat in a Heart Healthy Way—Even When Time or Money Is Tight
• Session 10 — Take Control of Your Health: Enjoy Living Smoke Free
• Session 11 — Review and Graduation
• Session 12 — Use Evaluation To Track Your Progress (Especially for Community Health Workers)
• Appendix — Activities for Training Community Health Workers

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:

• "With Every Heartbeat Is Life" manual and picture cards
• Blackboard and chalk or several large pieces of paper, markers, and tape
• How To Make an Artery Model
• How To Explain the Artery Model
• One empty paper towel roll
• Scissors
• Red construction paper and tape or red felt with sticky backing
• Red and yellow modeling clay
• Six paper plates
• Set of measuring spoons
• Can of shortening or lard
• Bottle of vegetable oil*
• Choice of three of the following foods:*
  • Cooked beans
  • Beef hotdog
  • Orange
  • Regular mayonnaise
  • American cheese
  • Fried chicken (wing and thigh)
  • Snack cakes (packaged cupcakes)

* You can use pictures of these foods.

Handouts

Give each group member these handouts during this session:

• List of places where group members can get their cholesterol levels checked^†
• "Take Action To Control Your Cholesterol"
• (Optional) "Make Your Health a Regular Appointment: A Role Play at Ms. Faye's Hair Salon"
• "Fats and Oils To Choose"
• "Read the Food Label To Choose Foods Lower in Saturated Fat, Trans Fat, and Cholesterol"
• "Pam's Breakfast Choices"
• "Guess the Fat Activity"
• "Cooking With Less Saturated Fat"
• "Recipe Substitutes"
• "Soul Food Makeover—Chicken Gumbo Recipe"

^† Prepare this list before the session. You may find information at your local health department, hospital, or clinic.

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?
   1. What Are Triglycerides?
   2. Metabolic Syndrome and Your Health
4. Healthy Arteries Activity
5. (Optional) Make Your Health a Regular Appointment: A Role Play at Ms. Faye's Hair Salon
6. Facts About Saturated Fat, Trans Fat, Cholesterol, and Fiber
7. Food Label Activity—Fats
8. Guess the Fat Activity
9. Cooking With Less Saturated Fat Activity
10. Making Your Favorite Family Recipes With Your Heart in Mind—Recipe Substitutions
11. Soul Food Makeover—Chicken Gumbo Recipe

Review of Today's Key Points

Weekly Pledge

Closing

Introducing the Session

1. Welcome
• Welcome group members to the session.
2. Review of Last Week's Session
• Say:
  Last week, we talked about salt and sodium.
• 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.
• To cut back on salt and sodium, you can:
  • Check the food label to choose foods lower in sodium.
  • Use herbs and spices instead of salt to season foods.
  • Eat more fruits, vegetables, and fat-free or low-fat milk products for snacks.
    People who have trouble digesting lactose found in milk products can eat or drink lactose-free products, such as low-fat soy milk.
  • Choose low-sodium or unsalted nuts, pretzels, and popcorn.
• Say:
  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.
• Ask:
  Has anyone completed the family health history?
  Note: Give a prize to group members who have completed the family health history.
• Ask:
  Do any of you want to share what you have learned about your family
  health history?
  Note: Allow 5 minutes for group members to respond.
3. About This Session
• Say:
  Sojourner Truth said, "It is the mind that makes the body."
• Ask:
  What does this quote mean to you?
  Note: Allow 5 minutes for group members to respond.
• Say:
  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.

Conducting the Session

1. Facts About Blood Cholesterol
• Say:
  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:
  • Nearly half of African American women and more than one in three African American men have a blood cholesterol level that is too high.
  • African American adults are less likely than white adults to have their blood cholesterol checked.
2. Cholesterol and Heart Disease
• Note: This section explains what cholesterol is, why the body needs cholesterol, how much cholesterol the body needs, and where cholesterol comes from.
• Say:
  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.
• Say:
  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 from 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 any of you know someone who has high blood cholesterol?
• Note: Allow about 2 minutes for group members to respond.
• Say:
  Several things affect your blood cholesterol level. You cannot change some of these things, 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.
• Say:
  You can help prevent or lower high blood cholesterol by:
  • 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.
• Say:
  Let's look at how cholesterol travels through the blood:
  • 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. 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 (liver).
    • 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.
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?
• Say:
  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 and 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?
  Note: Allow a moment for group members to respond.
• Give group members the "Take Action To Control Your Cholesterol" handout. 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.
• Say:
  

  Here are what the total cholesterol numbers (mg/dL) mean:

  Less than 200	Desirable—Keep up the good work.
  200—239	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	High You are at a higher risk for clogged arteries and a heart attack. Ask your doctor what your risk is for heart disease.

• Say:
  

  Here is what your HDL and LDL cholesterol numbers (mg/dL) mean:

  LDL (bad) cholesterol:	Keep it low!
  Less than 100	Desirable
  100—129	Near desirable
  130—159	Borderline high
  160—189	High
  HDL (good) cholesterol:	The higher the better!

• Keep it 40 mg/dL or higher.

More Information

Heart Disease Risk and Your LDL Level

The goal for the LDL (bad cholesterol) level is different for everyone. 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, 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.

1. What Are Triglycerides?
• Say:
  Have any of you heard of triglycerides?
  Note: Allow 2 minutes for group members to answer.
• Say:
  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.
• Say:
  A healthy triglyceride level is less than 150 mg/dL.
• Say:
  People with high triglycerides often have low HDL cholesterol (good cholesterol). People with diabetes can also have high triglycerides and low HDL cholesterol.
• Say:
  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 food and drinks high in added 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	Normal
150—199	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	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	Very high See your doctor immediately! This level requires attention to prevent severe problems with your pancreas.

• 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 on their wallet cards.
  • Give group members a list of clinics and hospitals where they can get low-cost or free blood cholesterol testing.
2. Metabolic Syndrome and Your Health
• Say:
  • Today we're going to learn about 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.
  • About one in five African American women has metabolic syndrome.
  • About one in seven African American men has metabolic syndrome.
• Say:
  Let's name the five factors that make up metabolic syndrome. Hold up your fist and raise one finger for each risk factor you have.
• Show picture card 5.5.
• Say:
  The five factors that make up metabolic syndrome are:
  1. A high waist measurement:
     • Greater than 35 inches for women
     • Greater than 40 inches for men
       
  2. A triglyceride level of 150 mg/dL or more
  3. A low HDL (good) cholesterol level:
     • Less than 50 mg/dL for women
     • Less than 40 mg/dL for men
  4. A blood pressure of 130/80** or more (either number that is high counts as a risk)
  5. Higher than normal fasting blood glucose (blood sugar) levels of 100 or more
• Ask:
  How many fingers (risk factors) do you have raised?
• Say:
  • If you have at least three of these factors, you have metabolic syndrome.
  • Metabolic syndrome raises your chances of developing heart disease, diabetes, or stroke.
  • People with metabolic syndrome should lose weight and become physically active.
• Say:
  If you think you have metabolic syndrome, talk to your doctor.

** The blood pressure level considered a factor for metabolic syndrome is 130/80. This level is different from the level that defines high blood pressure, 140/90.

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.
• Say:
  Blood flows freely to all cells of the body when arteries are normal and healthy.
• Say:
  When your LDL cholesterol is too high, cholesterol may become trapped in the walls of the arteries, causing them to harden. The opening of the arteries can become clogged and narrowed.
• Show the artery model.
• Note: See the next two pages to help you explain the artery model.
• Pass the artery model around so that group members can look at it closely.
• Ask:
  Have you ever seen someone fry food with lard and dump the hot lard down the sink?
• Allow a moment for group members to answer. Then ask them why they should not do this.
• Say:
  It is because the lard will clog the pipes. Foods high in saturated fat and trans fat will clog your pipes (arteries). So we want to treat our bodies just as well as we treat our pipes.

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
• red modeling clay
• 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.

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.

2. 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.

3. 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.

4. 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.

5. (Optional) Make Your Health a Regular Appointment: A Role Play at Ms. Faye's Hair Salon
• Note: Ask for two volunteers to be the actors in the role play. Give these two group members the "Make Your Health a Regular Appointment: A Role Play at Ms. Faye's Hair Salon" handout (pages 157). As the trainer, you can read the introduction.
• Ask:
  
  • What are some of the lessons you learned from this role play?
  • Is there any part of the role play that you can use in your own life?
    Note: Allow 5 minutes for group members to respond.
6. Facts About Saturated Fat, Trans Fat, Cholesterol, and Fiber
• Say:
  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 total fat found in food is its saturated fat plus its unsaturated fat.
  • Saturated fat is found in foods that come from animals, such as high-fat meat, cheese, milk, and butter.
  • A type of unsaturated 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.
  • 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.
• Say:
  It is important to limit the 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.
• Show group members a stick of butter (or a can of lard).
• Say:
  • 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.
• Say:
  Here are foods that are high in saturated fat:
  • Whole milk and products made from whole milk (regular cheeses and sour cream, evaporated whole milk)
  • Ice cream and whipped cream
  • Fatty cuts of meat, such as chuck steak, regular ground beef, ribs, pork chops,
    bacon, pork sausage, beef oxtail, Polish
    sausage (kielbasa), and liverwurst
  • Skin of chicken, turkey, and pig
  • Smothered meat and poultry dishes, such as smothered chicken or pork chops, made with animal fat or grease gravies
  • Chitterlings, which are also called chitlins (pork intestines); pickled pig's feet; and hog maws (hog stomach)
  • Oils such as coconut, palm, and palm kernel
  • Doughnuts, pastries, cakes, and cookies
  • Cornbread, hushpuppies, spoonbread, biscuits, and other breads made with lard, butter, or shortening
  • Beef or pork hotdogs
  • Foods fried in grease or lard (such as chicken, fish, shrimp, and french fries)
  • Butter
  • Shortening
  • Lard
• Show picture card 5.8.
• Say:
  Here are foods that are lower in saturated fat:
  • Lean meats such as loin, round, and extra lean ground beef
  • Fish and seafood
  • Turkey bacon
  • Poultry without the skin
  • Beans
  • Rice
  • Tub margarine
  • Fat-free and low-fat milk, cheese, yogurt, and evaporated milk (or lactose-free products for people who have trouble digesting lactose found in milk products)
  • Vegetable oil
  • Breads (made without butter or lard)
  • Fruits and vegetables
• Say:
  You want to limit the amount of saturated fat in your diet.
• Show group members a bottle of vegetable oil.
• Say:
  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.

More Information

Polyunsaturated fat is found in:

• Vegetable oils
  • Safflower 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.
• Say:
  The graph will quickly show you which products have the least amount of saturated fat.
• Ask:
  What three oils have the least amount of saturated fat?
• Say:
  Canola oil, safflower oil, and sunflower oil have the least amount of saturated fat.
• Say:
  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.
• Say:
  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:
  • Egg yolks
  • Organ meats, such as liver, gizzards, and chitterlings (chitlins)
  • Pig's feet
  • Whole milk products including butter, cream, ice cream, and cheese
  • Shrimp
• Show picture card 5.10.
• Say:
  Foods that come from plants do not contain cholesterol. Foods that do not contain cholesterol include:
  • Fruits, such as bananas, pineapples, mangos, and apples
  • Vegetables, such as tomatoes, green peppers, lettuce, and corn
  • Beans of all varieties
  • Rice, such as brown rice
  • Grains, such as those contained in corn tortillas and whole-grain bread
  • Cereals, such as oatmeal
• Say:
  Plant foods that are prepared with an animal product (for example, greens cooked with fatback or bacon grease) have cholesterol.
• Say:
  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.
• Say:
  Soluble fiber is found in foods such as oats, barley, fruits, 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.
• Say:
  Fruits and vegetables that are a good source of soluble fiber are citrus fruits (oranges and grapefruits), pears, apples, peaches, bananas, brussels sprouts, green beans, broccoli, cauliflower, peas, baked or sweet potatoes (with skin), corn, okra, cabbage, spinach, collard and mustard greens, and carrots.
• Say:
  For great sources of soluble fiber, try to include a variety of cooked dry beans. Avoid canned beans that contain high amounts of salt and sodium. Prepare beans at home, flavoring them with celery, garlic, and spices instead of salt.
7. Food Label Activity—Fats
• Give group members the following handouts: "Read the Food Label To Choose Foods Lower in Saturated Fat, Trans Fat, and Cholesterol!" and "Pam's Breakfast Choices".
• Point out on the food label where to find saturated fat, trans fat, and cholesterol.
• Show picture card 5.12.
• Say:
• 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 food label for whole milk.
• Say:
  Look at the bottom of the "Read the Food Label To Choose Foods Lower in Saturated Fat, Trans Fat, and Cholesterol" handout. Look at the Percent Daily Value for whole milk and fat-free milk. Which is lower in saturated fat?
• Say:
  Fat-free milk is lower in saturated fat. One cup of fat-free milk has no saturated fat. One cup of whole milk has 25 percent, or one-fourth, of the Percent Daily Value of saturated fat.
  Note: If group members should ask, explain that people who have trouble digesting milk products may use lactose-free products (such as soy milk). Although some of these alternatives may be lower in fat, they may not provide all of the other nutrients found in milk products. Recommend that they use calcium-fortified, lactose-free products.
• Say:
  Trans fat is now listed on all food 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.
• Say:
  Now look at "Pam's Breakfast Choices." We are going to use the food 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 food labels to find some solutions.

Pam's Problem

Pam has little time in the morning to prepare breakfast. She often has a
honey bun or a doughnut. Look at the food labels. Help Pam select some breakfast foods that are lower in saturated fat than her usual choices. Which should she choose? It is important to also compare labels for trans fat and cholesterol amounts.

Note: The correct answer is underlined.

• A honey bun or a plain bagel?

• A jelly doughnut or an english muffin?

• A banana muffin or a banana?

• Toast with butter or toast with light, soft tub margarine?

• Canadian bacon or pork sausage links?

• Low-fat American cheese or regular American cheese?

• 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.
8. Guess the Fat Activity
• Before the session
1. Buy a can of shortening or a stick of margarine. Also buy paper plates and three foods from this list (or use pictures of the food).
   • 2 ounces American cheese (about the size of a 9-volt battery)
   • 2 tablespoons regular mayonnaise
   • 2 pieces of fried chicken (wing and thigh)
   • 2 snack cakes (1 package of cupcakes)
   • 1 beef hotdog
   • 1 cup cooked beans
   • 1 orange

Foods	Teaspoons of Fat (Grams of Fat)
2 ounces American cheese (about the size of a 9-volt battery)	About 5 teaspoons (20 grams)
2 tablespoons regular mayonnaise (about the size of a ping-pong ball)	About 1¼ teaspoons (5 grams)
2 pieces of fried chicken (wing and thigh)	About 8½ teaspoons (34 grams)
2 snack cakes (1 package)	About 4½ teaspoons (18 grams)
1 beef hotdog (1.5 ounces)	About 4 teaspoons (16 grams)
1 cup cooked beans	About ¼ teaspoon (1 gram)
1 orange	None

2. Write the name of each food you bought on a separate plate.
3. Look at the following chart. Find the amount of fat for each food you bought.
   Note: You do not have to use all the food in the chart. Choose the foods that are eaten most often in your community.
4. Using the can of shortening, spoon the amount of fat listed in the chart onto the plate labeled for that food.
5. Take the remaining plates, and place each food item (or picture of food) on the separate plates.
6. Put all the plates away until you are ready to do the activity.
• Group activity
• Say:
  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.
• Give group members the "Guess the Fat Activity" handout.
• Show group members the plates of foods (or pictures of food) you prepared ahead of time.
• Say:
  Guess the number of teaspoons of fat that are found in one serving of each of these foods. Write your guess on the "Guess the Fat Activity" handout.
• Ask group members to tell you the amount of fat they guessed for the first food item. After group members have shared the amount they guessed, 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.
• Say:
  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, chips, 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. People who have trouble digesting lactose found in milk products should eat lactose-free 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.
• Say:
  There are lower-fat substitutes for some of the higher-fat foods we often eat.
• Review the following list.

Foods	Lower-Fat Substitutions
Regular Cheese	Fat-free or low-fat cheese*
Whole milk	Fat-free or low-fat milk*
Regular Sour cream	Fat-free or low-fat sour cream or plain yogurt*
Pork rinds	Low-salt crackers
Beef hotdog	Low-fat hotdog

*Or lactose-free products
• Say:
  You can also reduce the amount of fat you eat by simply eating foods higher in fat less often or in smaller amounts.
9. Cooking With Less Saturated Fat Activity
• Note: This section gives information to 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 in their diets without giving up their traditional foods.
• Ask:
  Before we do the next 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.
• Say:
  The next activity shows how to prepare foods with less saturated fat.
• Give group members the "Cooking With Less Saturated Fat" handout. Review each of the dishes listed. Ask volunteers to read each recipe out loud.
• Ask:
  Why are 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:
  • Beans are naturally low in fat, and no fat (lard, shortening, or oil) is added.
  • Boiled rice is naturally low in fat, and no fat is added.
  • The potato salad is made with low-fat or fat-free mayonnaise. A little mustard is added for great flavor.
  • The meats selected are lean and are loin or round cuts. Before cooking, the poultry skin is removed and all visible fat is trimmed. The meat and poultry dishes are baked, broiled, stewed, roasted, or grilled instead of fried or prepared with fat such as lard or grease.
  • The fish and seafood dishes are baked, braised, stewed, or grilled without using fat such as lard or grease.
  • The fat is drained from the cooked ground meats.
  • The fruit shake is made with fat-free milk instead of whole milk.
10. Making Your Favorite Family Recipes With Your Heart in Mind—Recipe Substitutions
• Say:
  Many of us have favorite recipes that have been in our families for generations. We don't have to give up cooking these recipes altogether if we want to be heart healthy.
• Give group members the "Recipe Substitutes" handout.
• Say:
  Let's read the recipe substitutions that provide some heart healthy options
  for ingredients and measurements common to many recipes.
• Ask for a volunteer to read the handout aloud.
• Try these substitutions the next time you are preparing one of your
  favorite dishes.
  
11. Soul Food Makeover—Chicken Gumbo Recipe
• Give group members the "Soul Food Makeover—Chicken Gumbo Recipe" handout.
• Ask:
  How has saturated fat been reduced in this recipe?
  Note: Allow a moment for group members to respond.
• Add the following answers if they are not mentioned:
  • The dish is made with chicken without the skin.
  • It uses chicken breasts, which are lower in fat than chicken thighs.
• Say:
  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.
• Ask if there are any questions. Encourage group members to try this recipe at home this week.

Review of Today's Key Points

• Say:
  Let's review what you've 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
• 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?
  • Fatty meat, including certain types of meat or animal cuts such as fatback, beef oxtail, and chitterlings (also called chitlins); poultry with skin; whole milk and cheese; butter; lard; and shortening
• 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 do not eat it.
  • Bake, boil, broil, or grill food instead of frying it.
  • 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), pears, apples, peaches, bananas, broccoli, baked or sweet potato (with skin), carrots, and collard greens

Weekly Pledge

• Say:
  You have learned a lot today about preventing 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. This will be your pledge for the week.
• 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 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.
  • I will try low-fat milk or low-fat, lactose-free products, starting this week.
    Note: Allow 5 minutes for group members to think of a pledge.
• Say:
  Write your pledge on the "Take Action To Control Your Cholesterol" handout. Keep this handout in a special place, so you can review your pledges and keep your goals in mind.
• Say:
  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.
• (Optional) Say:
  Keeping a personal value in mind can help you make changes in your everyday life to prevent and control high blood cholesterol. Remember that a personal value is a quality that you consider important.
  Today, the value is self-control. Before making lifestyle changes, it helps to prepare mentally to take control of your health. This is stated in today's quote, "It is the mind that makes the body." Self-control increases your ability to make healthy choices and to take responsibility for the habits you need to change. Self-control also helps you improve your eating habits. For example, it can help you limit portion sizes and stop yourself from going back for second servings.
• Ask:
  How could you use self-control, or another value, to help you keep your pledge?
• Note: Allow 3 minutes for group members to share their thoughts.
• Say:
  We will discuss the results of your pledges next week. Remember to continue to work on your pledge to be physically active and to reduce salt and sodium in your diet. Please continue to work on your family health history.

Closing

• Say:
  Thank you for coming today. What did you think of today's session?
• Note: Wait to see if group members have a response.
• Say:
  I am looking forward to seeing you at the next session. The next session will be about maintaining a healthy weight.
• Note: Think about today's session. What worked and what didn't work? Have you decided to make any changes in your own life based on what was covered in today's session?

Handouts

Last Updated December 2010