Healthy eating:
It’s all about baby steps
As Anna Ekpenyong tells the story, she was out shopping one day with a friend when she saw a dress that she liked.
She tried it on, but her regular size didn’t fit. Her friend tried to be helpful and suggested trying on a larger size.
“No way,” Ekpenyong told her friend. “I’ll lose the weight. Some people have three different dress sizes in their closet. But I won’t buy a different size of clothes to accommodate fat.”
And off she went.
At 80 years old, Ekpenyong has earned the right to do as she pleases. Fortunately for her, her choices on diet and food and fat have been right from the very start.
She summered in South Carolina with her grandmother, who planted her own vegetables and raised chickens. Her grandfather built boats and, as a result, brought home a lot of fish. From an early age, Ekpenyong’s diet consisted of fresh fruits, vegetables and lots of fish.
She says she never really liked soul food, a Southern style of cooking that she found too greasy and fattening. Even now, when she cooks greens, she uses only olive oil, celery and onions. Her friends are surprised that her greens are just as tasty without using meat.
“Vegetables are vegetables,” she explains. “If I want meat, I eat meat. I don’t particularly like meat in my vegetables.”
Ekpenyong knows how difficult a healthy diet can be for some folks.
“It’s hard to get people to change unless it’s for a medical reason,” she says. “People like what they eat. And I understand. I like the taste of what I eat — I couldn’t change my style either.”
Many people know that nutrition is an integral part of a healthy lifestyle and key to preventing or controlling several health conditions, including obesity and type 2 diabetes.
Kathy McManus, director of the department of nutrition at Brigham and Women’s Hospital, has worked in the world of nutrition for almost 30 years, and has seen the amount of attention paid to healthier eating grow exponentially.
“Probably about 15 years ago, we started seeing a growing interest from consumers and patients,” McManus says. “And they just weren’t talking about foods with their friends and neighbors. They were actually talking with their physicians about healthier foods. And nowadays, the amount of information is just incredible. This is a very exciting time.”
Exciting is one thing, but nutritional overload is another.
“Given the amount of information on nutrition these days,” McManus says, “it’s quite understandable how anyone can feel a little overwhelmed.”
As far as she is concerned, it’s all about taking baby steps.
The first such step she recommends is to start a food diary of everything you consume — including all beverages — from sunup to sundown. Once that is done for about a week, you can start looking at ways to eliminate some of the unhealthier foods and replace them with healthier substitutes.
For example, if you have a latte and two donuts every morning for breakfast, you might consider replacing that with a whole-grain English muffin and peanut butter.
The point, McManus explains, is patience.
“Don’t try to overhaul your entire diet in one week. It’s baby steps. Give yourself about a year,” she says. “These are habits that are going to take a while to change. But if you make one improvement a week, then keep it going.”
McManus was clear on another point. “There is no ‘yes-yes’ food or ‘no-no’ food,” she said. “It’s all about the total diet.”
One way to develop a balanced diet is to eat every day from the four basic food groups: fruits and vegetables, whole grains, meats and milk products, and a small amount of healthy fats. Healthy fats are those that are liquid at room temperature and include olive, canola, peanut, corn and safflower oils.
Most fruits and vegetables are naturally low in unhealthy fats, salt and calories, and contain important nutrients, such as potassium, fiber and vitamins. To get a healthy variety, choose different colors — the deep greens of broccoli, collard greens and spinach; the orange of carrots, acorn and butternut squash; the reds of strawberries and watermelon. Eat foods high in potassium, such as bananas, cantaloupe, apricots, lima beans and tomatoes.
A diet rich in fruits and vegetables may reduce the risk for stroke, high blood pressure, coronary heart disease, type 2 diabetes and even some cancers — all of which are common in blacks.
Grains are foods made from rice, wheat, oats, cornmeal and any other cereal, and are essential to a healthy diet. They contain fiber, iron and many B vitamins. Whole grains, such as brown rice, oatmeal and whole wheat bread, contain the entire grain kernel and are preferred over refined grain products, such as white bread, white rice and white pasta. Refined grain products are of finer texture but lack many of the essential nutrients found in whole grains.
The meat group contains meat, poultry, fish, eggs, legumes, nuts and seeds, and is a major source of protein in the diet — the building blocks for bones and muscles. The problem is that some protein foods are high in fat. For instance, a 6-ounce broiled Porterhouse steak is a good source of complete protein, but also contains a high level of fat, including saturated fat, which can raise LDL (the bad) cholesterol.
A healthier substitution for fatty meats is fish, poultry, legumes — lentils, pinto beans, black-eyed peas — or nuts and seeds.
Fruits, vegetables, whole grains, legumes and nuts are high in fiber — carbohydrates that cannot be digested. Fiber is not found in animal products. While fiber aids the gastrointestinal system by relieving and preventing constipation, some studies have shown that high intake of dietary fiber, especially cereal fiber, is also linked to a lower risk of heart disease.
Milk products — milk, cheese and yogurt — are important for calcium, potassium, vitamin D and protein. Calcium and vitamin D are needed for the health of bones and teeth, while potassium may help to maintain a healthy blood pressure.
One drawback of milk products is their high fat content; most milk group choices should be fat-free or low-fat.
There are some nutrients to avoid or consume in small quantities. Although sodium, or salt, is critical to the body, it can contribute to high blood pressure in people who are sensitive to it, and cause a buildup of fluid in those with congestive heart failure or kidney disease.
Because salt is hidden in many of the foods we eat — such as bacon, sausage, frozen and fast foods — we consume considerably more than the recommended teaspoon, or 2300 milligrams, a day.
Sugar should also be limited. Sugar is a carbohydrate that has many common names, such as brown or table sugar, confectioners and powdered sugar. But often sugar masquerades under other names — honey, molasses, maple syrup, high fructose corn syrup and ingredients ending in “ose,” such as lactose (found in milk) and fructose (found in fruit).
Sugar is a main ingredient in several beverages, such as sodas and energy and fruit drinks.
Given the amount of ‘hidden’ ingredients, it is little wonder that the nation is struggling with obesity and various medical conditions.
Among the biggest culprits are unhealthy fats. The body needs fats for energy, insulation and to help control inflammation and blood clotting.
But too much of the wrong type of fat can increase the risk of cardiovascular disease. The worst offenders are trans and saturated fats. Saturated fats are found in animal products, such as fatty meats and dairy products, or tropical oils, such as coconut and palm oil. Saturated fats increase LDL, or bad, cholesterol.
Trans fat packs a double whammy. It not only increases bad cholesterol, it decreases HDL, or good cholesterol. Trans fats are the worst fats in the diet and are found in fried foods, commercially baked goods, processed foods and fast foods.
So negative is the impact of trans fat on one’s health that New York City and Brookline have banned artificial trans fats from use in all restaurants, and Massachusetts is considering similar legislation.
But again, it’s about baby steps.
“It’s a good thing to have a lot of knowledge, but if you can’t put it into practice, then it’s all for naught,” McManus explained.
Of particular concern to McManus is the ongoing debate over the size of portions.
“Portions are out of control,” McManus says, blaming the current obesity epidemic in part on the “super-size” mentality. “And weight is critical, especially if the extra pounds have accumulated around the waist.”
McManus rattled off a list of suggestions, everything from using the salad plate instead of the full-sized dinner plate to eliminating second helpings.
“When you cook a meal and there are leftovers,” McManus says, “put the leftovers away in a storage container right away. If there is still food left on the stove, the temptation is high to have another helping.”
McManus also stressed planning. “Everyone would like to be able to come home from work and have a healthy, nutritious meal just sitting there waiting for you to pop in the microwave,” McManus says. “The reality is that we should plan ahead and think about the meals we are having during the week.
“If we know that we need more fruits and vegetables in our diets,” McManus continues, “then we should have — or at least try to have — an apple or a banana for breakfast and maybe some raw vegetables like celery or carrots with lunch. That way we don’t have to try to get everything in at the last minute.”
A good rule of thumb, McManus explains, is to divide your dinner plate into one-half vegetables, one-quarter grains and another quarter lean protein.
The important thing to remember is that changing eating habits is not spontaneous. It can take many years to get it right.
Besides a healthy diet, the other critical part of a healthy lifestyle is movement. The only way to get a handle on the obesity epidemic is to be more physically active each day. Simple things can make a difference, like getting off the bus one stop earlier, or taking the stairs instead of the elevator.
Ekpenyong has passed her good habits down to her daughter and granddaughter.
“My daughter is more of a health freak than I,” she says. “She’s a doctor and wants to make sure that the food we eat has enough fiber and other nutrients.”
Her granddaughter eats well, but sometimes complains that she’s a child and should be able to eat fast food.
But even she has the health bug. When recently given the option of McDonald’s or a healthier take-out meal, she said, “Well, I haven’t had McDonald’s all year, so I’ll finish out the year without one.” |
| Anna Ekpenyong monitors the nutrition of her family as well as the community. For 11 years, she has run the weekly food pantry at Twelfth Baptist Church in Roxbury. |
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Kathy McManus, M.S., R.D., L.D.N.
Director, Department of Nutrition
Brigham and Women’s Hospital
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