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Educational materials
EDUCATIONAL MATERIALS Edited by S. A. Berkowitz. Reviews Editor Reports. audiovisuals. and other resources that nutrition professionals may use for reference or continuing education are designated "professional." Curricula. audiovisuals. and other materials designed for use with children in formal or informal education settings are listed under "classroom." Handouts. diet plans. and other materials intended for education of patients and the general public are categorized as "consumer education and counseling . .. Inclusion of any material in this section does not imply endorsement by the Society for Nutrition Education. Evaluative comments contained in the reviews and summaries reflect the views of the authors when signed. All unsigned reviewed are the responsibility of the reviews editor. - - - PROFESSIONAL ------, REPORT
Assessment of the Iron Nutritional Status of the U.S. Population Based on Data Collected in the Second National Health and Nutrition Examination Survey, 1976-1980. Pilch. S., and F. Senti, eds.• 1984. From Life Sciences Research Office, Federation of American Societies for Experimental Biology, 9650 Rockville Pike. Bethesda, MD 20814. 122 pp. softcover. $12. postpaid. This is a very technical document that can best be used by researchers and by those who plan health surveys. It may also prove useful to policymakers and clinical diagnosticians. The report contains excellent background information on iron storage, iron turnover, and the stages of iron deficiency. The report discusses the relationship of these phenomena to biochemical measures, and provides a good summary on the consequences of iron deficiency. The discussion of the methodology, including limitations. significance of results, sources of error. and interpretation of results, should be particularly useful to researchers and to diagnosticians. For example, in selecting methods to determine the iron status of groups or individuals, it is essential to know that serum ferritin measures the VOLUME 18
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status of iron stores, while mean corpuscular volume (MCV) measures red cell iron levels. These distinctions are important in differentiating between mild and severe iron deficiency. Unfortunately, the report is rather difficult to read, and would possibly have wider appeal if this were not so. The report also contains some inconsistencies. For example, in one section the statement is made that the number of black subjects included in the survey was too small for the reliable determination of the prevalence of low hemoglobin concentration, but in another section, there is a statement that blacks tended to have a higher prevalence of abnormal values for iron status indicators than did whites. The report offers four recommendations for additional analyses on the NHANES data. However, the rationale for such analyses is not self-evident, and it is not discussed. On the other hand, recommendations for future surveys are well stated. The report also documents shortcomings in earlier surveys and suggests changes that should be made to correct these shortcomings. Overall, the report contains valuable information, but only for a very limited audience. Gwendolyn Washington PIa. Ph.D., Assistant Professor. Howard University, College of Dentistry, Washington. DC 20059. WORKBOOKS
Building Nutrition Counseling Skills, National Institutes of Health, 1984. From U.S. Government Printing Office, Washington, DC 20402; vol. 1: A Guidebook for Workshop Planning, 37 pp., softcover, spiralbound, SIN: 017043-00108-7, $3.75; vol. 2: Workshop Resource Manual, 236 pp., softcover, spiralbound, SIN: 017-043-00107-9, $8.50.
The heart of practicing nutritionists' work lies in skillful and sound personcentered nutrition counseling. To this end. these two manuals from NIH are welcome additions to help practitioners build the personal skills required to meet current health-care needs. The authors call counseling skills "people skills" because these skills are used to help people make positive
health-behavior changes. Counseling is a dynamic process involving many psychosocial elements, interviewing skills, active listening, and. at times. wise use of confrontation. The manuals cover a broad range of topics related to both process and skills development. as well as multiple applications in general practice. The authors' goal is to assist nutrition educators and practitioners in planning and implementing workshops in nutrition counseling. I also find the material helpful in daily work with individual patients and clients. The format makes the material easily accessible. I especially liked the Learning Experience Descriptions (LEDs), a veritable catalog of nutrition counseling activities. All of these LEDs are based on tested activities from the developmental projects for this work at the University of Iowa and the University of Pittsburgh. The writers' collaborative achievement is reflected in a recent award that the sponsoring agency-the National Heart, Lung, and Blood Institute of NIH-received from the National Association of Government Communicators' 1985 Blue Pencil Contest in the category of technical or professional publications. The strengths of these manuals lie in the soundness of their information and their multiple applications for use in practice. I find only one personal annoyance-the use of the term "compliance," a vestige of the traditional authoritative medical model, strangely out of place in this context of personcentered care based on behavioral selfcare change. I prefer the term "adherence." a term that the authors have used elsewhere. Because of their quality and scope, I recommend the use of these manuals on two levels. Certainly they are excellent guides as the authors intend for organizers of nutrition counseling workshops. But I also find here much sound and realistic material that can be used by practicing nutritionists and dietitians in their daily work with clients and patients who are taking steps toward positive health behavior changes. Sue Rodwell Williams, Ph.D.. M.P.H., R.D., Private Practitioner and Author. 640 Hilldale Ave.. Berkeley, CA 94708. JOURNAL OF NUTRITION EDUCAnON
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EDUCATIONAL MATERIALS FILM
The Enigma of Anorexia Nervosa, 1985. From Carle Medical Communications. 510 W. Main St.. Urbana. IL 61801. three parts: part 1: Delusion and Discord, 18 min .• part 2: Clinical Intervention and Rehabilitation, 16 min., part 3: The Battle of Wills, 26 min., complete program: 3/4", VHS. Beta II. $850; each part: $325; 1-week rental of complete program: $135; 3-day rental of any part: $50.
It is estimated that anorexia nervosa affects as many as one in two hundred white females between the ages of twelve and eighteen. Yet many parents. educators, and health professionals are unaware of the early symptoms of the disorder, or of the necessity for professional intervention to address both the malnutrition and the underlying psychological disturbances. Many anorectics require hospitalization at some phase of their treatment; this can be an especially trying time for patient, parents, and hospital staff. This film is therefore a welcome resource for nurses and other health professionals who will deal with hospitalized anorectics. Part one offers background information on the history of anorexia, and includes a thorough discussion of the biopsychosocial factors involved in both anorexia and bulimia. These factors are presented on a continuum of eating disorders; the anorexic constriction is at one extreme and the anorexic bulimic is at the other. Although the American Psychiatric Association's Diagnostic and Statistical Manual (DSMIII) currently lists bulimia as a separate eating disorder, there is at least some evidence for an overlap in the two conditions; and this continuum can be a useful construct for viewing the larger problem of eating disorders in this society. Viewers ofthis segment will need a health/medical background to understand what is a fairly technical presen-
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tation; later review of the salient points would also be useful. The second part covers clinical intervention in the hospital setting, and includes both assessment and treatment. Specific clinical symptoms of anorexia are detailed for use by nursing personnel. Components of the initial assessment are reviewed, including a complete physical examination, a patient history, and a family history. A nutritionist then presents various options for refeeding patients, including situations that require naso-gastric tubes or total parenteral nutrition. Careful refeeding is necessary to prepare patients for psychotherapy and to counter the toxic effects of malnutrition, while avoiding both the physiological and psychological damage of refeeding too rapidly. Part two focuses on the team approach to patient management and the key role of skilled nursing care for recovery. Part three covers specific areas in the care of the anorectic patient through a case study presentation interspersed with comments from the nursing consultant for the film. This is an excellent approach for conveying the attitudes of both the patient and the staff, and for portraying the anorectic's skill at manipulating adults in her environment, and 'sabotaging their efforts to refeed her. Although targeted to hospital personnel, this film would be appropriate for a wide range of professionals, particularly those who interact with adolescents and young women and who are in a position to promote early diagnosis and treatment of anorexia. The film is an excellent review for nutritionists and dietitians, and could also be used effectively in training courses for physicians. nurses, dietitians, and students in allied health fields. Some users would benefit from access to a study guide, as the film does cover a fair amount of technical material. GUIDE
Guide to Mass Media and Support Materials for Nutrition Education in Developing Countries, Griffiths, M., et aI., 1985. From International Nutrition Communication Service, Educational Development Center, 55 Chapel St., Newton, MA 02160,128 pp., softcover, $10 prepaid, free to developing countries. Nutrition educators working in developing countries are always looking for new and effective approaches. Frequently, money and time have been lost
because projects have been initiated without the proper "know-how." This book provides some refreshing directions to prepare educators for new projects. This guide provides an overview of the communications approach to nutrition education and focuses on how to use mass media and support materials to get the message across. After reviewing some 300 educational materials, the authors extracted and presented some of the most successful ones along with guidelines for their effective adaptation for use in other situations. The book begins with a description of the five major elements in the art and science of developing nutrition education materials-identifying the nutritional and educational priorities and goals; involving the target group in the development process; following message and materials design principles; designing materials in line with an overall media strategy; and field testing with the target audience. Also included at the outset is a section on how to use the guide as well as a glossary of communications terminology. The major portion of the guide is devoted to reviews of successful nutrition education projects undertaken in various developing countries around the world. The authors reviewed and presented projects under the following major headings: nutrition for the family, maternal nutrition, young child feeding, growth and monitoring, and nutrition-related health problems. Clearly reproduced photographs of the materials are presented along with reviews. A useful organizational feature is that the user gets to see several approaches to a single problem (e.g., weaning) and, therefore, is able to see at a glance how various administrations have handled a particular problem. As a nutrition educator in Jamaica, I was pleased to see that representative materials from my country were included. I am sure that readers in other developing countries will find the same completeness. Nutrition educators will appreciate the pull-out Nutrition Education Game, which will prove useful for programme planning and evaluation exercises. I also recommend this game as a useful teaching tool for in-service training programmes. Also valuable is the inclusion of contacts (with addresses) where readers can obtain copies of materials they wish to use. Although designed primarily for nutrition educators in developing counVOLUME 18
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EDUCATIONAL MATERIALS tries. the guide would be valuable in any training programme that focuses on public health nutrition. It is an excellent reference for developing nutrition education materials and should be a useful addition to the libraries of nutrition educators. especially in developing countries, Pauline M. Samuda, B.Ed., Nutritionist, Manchester Health Dept., Mandeville Post Office, Jamaica, West Indies. MONOGRAPH
New Developments in Nutrition Education, Nutrition Education Series Issue 11. Turner. S. and R. Ingle. eds., 1985. From UNESCO. 7 Place de Fontenoy. 75700. Paris, France, 232 pp .• softcover. free. What do children in India. New Caledonia, the Netherlands. Israel. and Brazil have in common? They have all been involved in nutrition education projects that are discussed in this monograph. A conference. sponsored by the science education department of the University of London Institute of Education and UNESCO. was held in July 1983 to discuss new developments in nutrition education. Topics discussed included: 1) training and educational methods used in primary and secondary schools; 2) programs for improving pre- and in-service teacher training; 3) effective use of mass media to support educational efforts; 4) coordination of government agencies and development of food and nutrition education policies; and 5) development of programs to assess and evaluate teaching and learning programs. The theme reflected throughout this monograph is that effective nutrition education involves having a good knowledge of a community-its needs. problems. and priorities-and using this knowledge to design educational programs of practical significance to its people. In general. a multidisciplinary approach and recognition of environmental and socioeconomic factors that influence eating behavior were important to the design of educational programs that changed attitudes and knowledge. and positively altered eating behavior. This monograph will be of interest to all nutrition educators. especially those in the United States. It provides a rare opportunity to learn about nutrition education efforts taking place in other developed countries as well as in developing countries in Africa. South America. Europe. and the Far East. VOLUME 18
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Pamela Ching, M.S., R.D., Pediatric Clinical Nutritionist, Dept. of Nutrition, The Johns Hopkins Hospital. 600 North Wolfe St., Baltimore, MD 21205.
RESOURCE MANUAL
Nutrition for the Elderly, Rosovski, S., and M. Nelson. 1985. From Brookdale Institute on Aging. Columbia University. 622 West 113th St.. New York. NY 10025, 64 pp., softcover. spiralbound. $6.95. This manual is one of a series of resource manuals planned by the Brookdale Institute on Aging to meet the educational needs of individuals in the fields of gerontology and geriatrics. This publication is specifically intended for those persons concerned with proper nutrition of elderly individuals. The manual is divided into two sections and has sixteen tables and four figures. The first section discusses current theories and research findings concerning nutrition and aging and delineates what this research suggests. The coverage of the field is succinct. . complete. up-to-date. and easy to understand. In particular. the discussions about fiber. vitamins. and minerals are well done. and the tables on drug-nutrient interactions and "non-vitamins" nonessential to health are helpful for easy reference. Using the dietary recommendations resulting from the cited research. in section two the authors provide-by means of extensive tables and sample menus-practical guidelines for feeding elderly individuals. In addition. throughout the section great care is taken to stipulate how certain factors such as individual health status. physical disabilities. personal preference. and behavior may necessitate modification of general guidelines to adequately meet an elderly person's specific needs. In summary. the manual is well written, readable. and a good source of basic material on nutrition for elderly persons. It should be a useful resource for health professionals and educators. human service providers. consumers. and students. as well as for senior citizens interested in maintaining their well-being through proper nutrition. Gertrude C. Kokkonen, B.A .. Chemist, Gerontology Research Center, Francis Scott Key Medical Center. Baltimore. MD 21224.
REPORT
The Reexamination of the GRAS Status of SuIfiting Agents. Life Sciences Research Office. Federation of American Societies for Experimental Biology. 1985. From FASEB Special Publications Office, 9650 Rockville Pike. Bethesda, MD 20814, 96 pp .. softcover, $12. Given a relatively clean bill of health in 1976 by the Select Committee on GRAS Substances. sulfiting agents have since been reported to cause adverse. sometimes life-threatening reactions in sensitive individuals. This technical report, commissioned by the FDA. thoroughly reexamines the safety of the sulfiting agent group of food additives (potassium bisulfite. potassium metabisulfite. sodium bisulfite, sodium metabisulfite, sodium sulfite, and sulfur dioxide). These additives act as antioxidants. help to prevent browning. and serve various other purposes in food. Supported by over 150 specific references. the report reviews available evidence on consumer exposure data. biological studies. and sulfite-sensitivity reactions. Sulfiting agents have not been found to be teratogenic. carcinogenic. or mutagenic in animals. At present, estimated average sulfite consumption is about the same as reported in 1976. and the current report agrees with the 1976 recommendations on safe levels to avoid chronic toxicity. There have been two major developments since 1976: the widespread use of sulfiting agents to preserve freshness in raw fruit and vegetable salad ingredients. and the recognition of bronchial hyperreactivity reactions in a small percentage of asthmatic patients following modest doses of sulfiting agents. The report formally affirms the safety of sulfiting agents for the general public but declares the possibility of severe hazard for those who are sulfite-sensitive. Moreover. the report notes that new labeling requirements will not be adequate to protect sulfite-sensitive individuals, and suggests that curtailment of sulfite use on fresh fruits and vegetables should be encouraged by the regulatory process. Acting on the findings of the report. the FDA, in August 1985. proposed a ban on such uses. This authoritative report is already influencing regulation of sulfiting agents. and is a valuable reference for research libraries and specialists in food science and public policy. What is lacking is a thorough but concise execJOURNAL OF NUTRITION EDUCATION
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EDUCATIONAL MATERIALS utive summary that could have helped the nutrition educator interpret these findings for the general public. Kathleen M. Koehler, Ph.D., Assistant Professor, Dept. of Family Studies, University of New Mexico, Albuquerque, NM 87131.
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CLASSROOM - - - - , SOFTWARE (1-ADULT)
Food for Thought, Marshware, 1985. From Marshfilm Enterprises, Inc., Box 8082, Shawnee Mission, KS 66208, available for Apple II, disk with documentation, $39.95. Also available: You Are What You Eat, 1985, available for Apple II, disk with documentation, $39.95. Can microcomputers teach nutrition concepts? That is what these two software packages attempt, using different approaches. Since the software was designed to be appropriate for learners aged seven through adult, I recruited a seven-year-old first-grader to assist in this review. Both packages were evaluated using an Apple lIe microcomputer with a monochrome monitor. Color monitors can be used but are not essential. The Food for Thought package uses a tutorial approach to promote knowledge of the Basic Five Food Groupsthe foods included in each group, and their nutritional contribution to the diet. My seven-year-old co-reviewer enjoyed using the program, and it did motivate him to learn about his diet. However, I was concerned that much of the information was oversimplified and thus misrepresented nutrition facts. Examples include statements such as "sugary foods provide you with a quick burst of energy" and "carrots may help you see better at night." The program includes a built-in teacher management system to keep records of pupil performance on a randomly generated 20-question quiz. Overall, however, this package has poor design features. For example, there is too much text on the screen per frame, the vocabulary is too sophisticated for some young users, and illustrations are ineffective and contribute little to motivating the user. Also, because the program lacks printout capabilities, hard copy cannot be generated for handout purposes. Based on cost, oversimplified content, and ineffective 42
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design features I cannot recommend this program. The second program, You Are What You Eat, uses the Basic Five Food Groups as a basis for evaluating diets. The program allows pupils to make entries from a list of foods eaten during a day, and the computer, which addresses the pupils by their first names analyzes the diets. The analyses indicate whether the students meet, exceed, or fail to meet the recommended intake for each food group. One of the program's shortcomings is that although it is designed for ages seven through adult, a single set of criteria is used to evaluate the diet of all age groups. Another major flaw is that no recommendations are made to suggest dietary improvements when targets are not met or when fat and sugars are used too liberally. Therefore, the relationship between good eating habits and health, a major educational objective of the program, is not addressed. A final flaw is that portion sizes are not listed for the foods. However, three features redeem this program: 1) printouts of the analysis can be generated for further study; 2) foods can be added to the food lists; and 3) the program stimulated interest in nutrition on the part of my seven-yearold co-reviewer. Notwithstanding, the cost and the fact that the diskettes cannot be duplicated for back-ups may limit classroom utility. A final word of caution: Since many software companies do not permit previews of their products, it is important for potential buyers to find out prior to purchasing a software package whether a nutritionist/programmer was involved in· developing the package. The development of good educational software is still in the early stages and, in nutrition, we have a long way to go. John Orta, R.D., M.S., M.S. Ed., Ed. M., M.A., Associate Professor and Chairperson, Dept. of Nutrition and Dietetics, Pratt Institute, Brooklyn, NY 11205.
becomes a personalized story of a child's health history. It begins with information on the child's prenatal period and birth data and moves into growth and development, immunization history, feelings and socialization, and finally the establishment of good health habits. Interspersed throughout are statements and workbook tasks aimed at enhancing a child's self-concept as well as implanting good health habits. While I find the goal of this book admirable, I have problems with its style and content. The rabbit illustrations are poorly drawn and are used inappropriately to represent young children. Why not show children hugging and children wearing seat belts instead of rabbits performing these activities? The book's hand-lettered style (which looks like pen over words outlined in pencil) is distracting and looks unprofessional. The health concepts in this book deserve more attention than they receive. There is scant coverage of personal safety and the prevention of accidents, dental health and the prevention of sexual abuse are virtually ignored, and the nutrition section consists of pictures of foods to be cut and pasted under headings for each of the Four Food Groups. From my experience with preschoolers, I believe they are ready for and interested in much more sophisticated nutrition education techniques than cutting and pasting. While this workbook idea may have some usefulness in the home setting for parents and their children, I do not recommend it for use in preschool settings. Sensitive teachers and a comprehensive curriculum that includes basic health information will accomplish much more in establishing good health habits in children. Kari Ostheller, R.D., M.P.H., Nutritionist with Daycare, W.I.G., M.C.H., Seattle-King County Health Dept., 1406 Public Safety Bldg., Seattle, WA 98104.
WORKBOOK (P)
Nutrition Express, Jacobson, M., and D. Riggs, 1985. From Center for Science in the Public Interest, 1501 16th St., NW, Washington, DC 20036, available for Apple II, floppy disk, Nutrition Scoreborad poster, $39.95 prepaid. What would you buy a friend with a fistful of fodars? This is the question facing players of this program. Players have the opportunity to answer questions about foods and nutrition and re-
SOFTWARE (4-8)
Healthy Happy Me, Calkins, H., 1984. From Resources for Children, Youth and Families, Box 1469, Scottsbluff, NE 69361, 40 pp., softcover, $4.25. Looking like a distant relative of Bugs Bunny, "Habit Rabbit" is the central character in this preschool health book. This workbook is intended to be completed with the cooperation of parents, teachers, and the preschool child and
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EDUCATIONAL MATERIALS view clues to future questions. Correctly answered questions earn points, called fodars, that are later exchanged for foods at the game's supermarket. During the game, players are given the chance to exchange foods between food groups to improve the nutritional quality of their chosen diet and their final score. Nutrition topics include sodium, cholesterol, caloric content of foods, fat, calcium, and sugar. Foods purchased with earned fodars are rated according to food category and the nutritional value assigned to each food. A player's final score depends on the balance of foods selected and the nutritional value of the foods. The game is over when the player reaches "FodaFoda Headquarters." Then the player's food selections are scored, and the final score is given in terms of the number of FodaFodas (natives of FodaFoda) the player may take home. A summary of the number of correct and incorrect answers given by the player during the game is also provided. Designed for middle school and junior-high school students, age nine years and older, the questions are written at an appropriate reading level. Also, the content of questions is technically correct. Menu driven, the game provides written instructions on the screen with help screens available during the game. The database contains a limited number of foods to select from during the game. Citrus fruits are an obvious omission. Also, ethnic foods and more commonly eaten foods are not included. Iron-rich foods such as liver and red meats are either omitted or are given lower nutrient scores. Although the branching of the program can help retain student interest, and sharpen problem-solving skills, it may prove confusing to some students in that the method of play can become tedious. For example, a skilled player may move rapidly through all major locations, answering questions correctly, and then become trapped within the game due to limited opportunities given to reach "FodaFoda Headquarters." Once questions are answered at a location, there are no additional points to be gained by a player returning to that location, and travel between locations costs the player points. Thus, a skilled player may lose points moving from location to location (in search of the headquarters) while trying to end the game. The complexity of the point system, moving between locations, and VOLUME 18
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exiting the game may be too difficult for younger students, depending on their ability to analyze and solve problems. Since classroom activities and discussion questions are well written, they should stimulate students' interest in general nutrition and help students to analyze their personal nutritional habits. The limited number and types of foods combined with the complexity of the game, indicate that the software is not a stand-alone nutrition unit. Further instruction is necessary to provide students with a more complete understanding of nutrition as it relates to their lifestyle and current situation. The program may be best used as an introduction to timely topics in nutrition or as a review of information. Mary Helen Mays, Ph.D., R.D.lL.D., Nutrition Consultant, 5401 14th St., Lubbock, TX, 79416. WORKBOOK/HANDBOOK (4-9)
You're SomeBODY: How to be a slim kid, Corby, L., and P. Clark, 1985. From Fifth House Publishers, Ltd., 406 Clarence Ave. S., Saskatoon, Saskatchewan S7H 2C7, Canada, 122 pp., softcover, spiralbound. Also available: SomeBODY's Companion, 44 pp., softcover, $18.95 for the set.
ture an overweight child while learning how to help the child improve activity and nutrition habits. The books were developed for use in Canada and therefore contain the Canadian Food Guide and list professional resources available in Canada. However, the books could easily be adapted for use in the United States. Although a minimum age of nine is mentioned, it is not entirely clear what age group this set of materials is appropriate for. By selecting specific sections according to reading level, the child's workbook could be used for boys and girls age nine to fourteen. The parent's volume would be improved by adding more information about growth and development and normal fat patterning in growing children, but this information could be provided by a workshop leader who would guide parents in the use of this handbook. I highly recommend this set of materials to professionals as a resource for activities when treating childhood obesity in a clinic or workshop setting, and to parents who want to learn more about promoting good health habits in their children. Ruth W. Crocker, R.D., M.Ed., Family Consultant, Children's Weight Control Program, The Children's Hospital, Fegan 6, 300 Longwood Ave., Boston, MA 02115.
CONSUMER EDUCATION ] ~----- AND COUNSELING
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MANUAL
At last! A creative and factual approach to childhood obesity designed for parents and children. This set contains a workbook for children and a separate handbook for parents. The children's workbook focuses on learning experiences designed to improve selfimage, increase physical activity, and promote sound food habits. The parent's handbook is packed with information and learning activities that will help parents or other concerned adults (companions) to understand and nur-
Diabetes Mellitus: A manual for patients, Pearson, J., 1983. From Diabetes Education Center, Mercy Hospital of Watertown, 218 Stone St., Watertown, NY 13601, 236 pp., softcover, spiralbound, $6 plus $1.50 postage. Most diabetes educators are probably familiar with the image of a diabetic patient leaving the office clutching a handful of pamphlets, handouts, Xeroxed sheets, and written notes that attempt to explain diabetes, exchange lists, the client's diet and so on. This manual on diabetes mellitus is therefore a welcome solution to this problem, providing in one spiralbound volume a complete, clearly written handbook for those who have diabetes. The manual is divided into colorcoded sections for easy reference and the typeface is larger and easier to read JOURNAL OF NUTRITION EDUCATION
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DIABETES MELUTUS
than that found in most educational pamphlets. Topics covered include an overview of diabetes, keeping in control, medication, uncontrolled diabetes, personal hygiene, and special situations. The manual also contains a glossary and reference section with information on cookbooks and magazines of interest to those with diabetes. The diet section is exceptionally complete, with exchange lists for ethnic foods, alcoholic beverages, fast foods, and prepared foods. The manual also includes recipes, and there is information on calculating food exchanges from labels-although this process is somewhat complicated and may be of more use to the diabetes educator than to the patient. Other sections of particular interest, often overlooked in diabetes education materials, address the psychological aspects of diabetes and issues relating to sexuality and pregnancy. Two minor criticisms of the manual: The quality of the graphics is very poor and detracts from the overall appearance of the manual, and the pages are not numbered, an omission that would be particularly annoying if the manual were used in a group teaching setting. Both problems could easily be remedied, however, in a future edition of the manual. This manual is a complete, low-cost diabetes education reference for health professionals and should be an integral part of every diabetic education program. Susan Greathouse, M.P.H., R.D., Nutrition Instructor, EFNEP, U.C. Cooperative Extension, 100 37th St., Room 117, Richmond, CA 94805. HANDBOOK
Diet and Diabetes, Patient Handbook 21, Thomas, B., 1984. From Churchill Livingstone Inc., 1560 Broadway, New York, NY 10036, 97 pp., softcover, $3.50. In short, incisive chapters this book reassures apprehensive, newly diagnosed diabetic adults and parents of diabetic children. A typically British "let's get on with it" approach explains 44
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how to adapt new dietary restrictions into present lifestyles. If there is a fault in this otherwise easily read and understood handbook, it is that the author uses British food terminology, which will be unfamiliar to most American readers. The diabetic foods mentioned do have counterparts in our supermarkets, but no reference is made to them. The author is also more lenient in his recommendation of the use of alcohol by diabetics than is the American Diabetes Association. In addition he favors the use of candy rather than fruit as a source of quick energy. However, he does debunk old myths that suggest diabetes is caused by eating too much sugar, and encourages adapting family meal plans to the new circumstances. Illustrations of menu adaptations, tables of the carbohydrate values of different foods, and recipes for patients who have diabetes are included as well as special hints for traveling, eating out, illness and holidays. A low-fat diet is recommended, not only to avoid obesity but also to avoid the heart disease complications that persons who have diabetes are prone to. However, the author does not differentiate between the use of saturated and unsaturated fats. They. are lumped together and some confusion is bound to result. Despite the weaknesses that I have pointed out, this handbook gives a straightforward account of a very complicated disease. The book is sure to give diabetic patients confidence in their ability to cope with the disease, and I do not hesitate to recommend it. Marianne Rosen, R.D., M.A., Private Practice, 68 Sprain Valley Rd., Scarsdale, NY 10583. BOOKLET
A Gift of Love: Breast feeding, American Academy of Pediatrics, 1984. From American Academy of Pediatrics, Publications Dept., Box 927, Elk Grove Village, IL 60007, 24 pp. booklet, $1.25, bulk rates available. As the number of mothers who are breastfeeding their infants increases so does the need for practical, easy-to-understand, accurate information to educate those mothers and answer their questions. This booklet successfully meets this need. Written for mothers, health professionals who care for mothers and babies, and those who want to encourage breastfeeding, this booklet discusses old wives' tales, where to get help for
problems with breastfeeding, and frequently asked questions about breastfeeding and weaning. It also includes a daily food guide (with information about nutritional needs) for nursing women and provides valuable tips on how to begin breastfeeding, how to continue nursing if you work outside the home, and how to recognize common breastfeeding problems. Because the booklet offers clear explanations and avoids jargon, individuals with little or no knowledge about breastfeeding will have access to basic and in-depth information. The question-and-answer portion is especially valuable due to the prevalence of myths and misinformation surrounding breastfeeding. The booklet's size, length, format, and graphics will also add to the enjoyment of the reader. The food guide, which is an insert in the middle of the publication, lists suggested servings of food based on a variety of food groups. Although food groups are used in designing adequate nutrient intake, creating meals based on this system may be difficult for some women with little or no nutrition knowledge. Including sample meals or menus would have made this section more meaningful to the reader. As a dietitian, I found this booklet a valuable resource, which I will recommend to mothers as well as to other health professionals. As a mother of two breastfed children, I especially appreciated the candid and caring approach to the subject of breastfeeding. This resource is excellent and should help dissipate fears and anxiety about breastfeeding. Felice D. Kurtzman, M.P.H., R.D., Senior Dietitian, Student Health Service, University of California, Los Angeles, Los Angeles, CA, 90024. DIET PLAN
Heart Smart: A plan for low-cholesterolliving, Becker, G., 1985. From Simon & Schuster, 1230 Avenue of the Americas, New York, NY 10020, 192 pp., softcover, $5.95. One of the greatest challenges faced by anyone attempting a reduced cholesterol and saturated fat diet is to plan food intake in accordance with the suggested percentages of macronutrients and various types of fat. The author has developed an inventive exchange system with seven food groups that does this for the reader. The book begins with a brief discussion of the theory behind the development of atheroscleroVOLUME 18
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EDUCATIONAL MATERIALS sis and a summary of behavior modification techniques for changing eating and exercise habits. It also contains recipe modification tips, shopping suggestions, low-cholesterol food substitutions, and hints for eating on special occasions. The final section of the book contains over one hundred recipes, including nutrient analyses. Both the strengths and weaknesses of this book lie in its simplicity. The author's use of analogies, graphs, drawings, and an excellent recipe index make most topics presented easy to comprehend. However, some areas are dealt with so briefly that I doubt whether the average layperson will understand, let alone master them. For example, only 1600- and 2000-calorie diet patterns are presented. The reader is told to use a ratio based on his or her own calorie needs to calculate an individualized pattern. Because this method often leads to fractions of food groups, it will undoubtedly be confusing to the reader: What does one do with one-fourth of a grain exchange? Also, although ideas for modifying recipes are given, the information necessary to incorporate these ideas into the exchange system is not provided. These and similar limitations could
lead to reader frustration and noncompliance. Overall, the strengths of this book outweigh its weaknesses. It is suitable as a beginning reference for patients who have to lose weight as well as reduce serum cholesterol. However, it should only be used under the supervision of a registered dietitian who can explain and individualize the diet plan. Barbara J. Visocan, M.S., R.D., Chief Clinical Dietitian, Dept. of Food and Nutrition Services, Hahnemann University Hospital, Broad and Vine Streets, Philadelphia, PA 19102. POSTER
Sugar Scoreboard, Center for Science in the Public Interest, 1985. From CSPI, 1501 16th St. NW, Washington, DC 20036, 18" x 24" wallchart, $3.80 each or $7.30 each laminated, bulk prices available. This colorful wallchart is a clear and provocative educational tool that will initiate lively discussion about the sugars manufacturers add to processed foods. The scoreboard lists over 200 convenience and snack foods and, for each, the percentage of calories from added sugar. The number of teaspoons of sugar per serving is graphically sym-
bolized by small black squares which, lined up in ascending order, make a strong visual statement. Sandwiched between the lists is concise, objective information: a discussion of the controversies and potential health risks of a high-sugar diet, definitions of common commercial and natural sugars and artificial sweeteners, and suggestions for decreasing dietary sugar and minimizing tooth decay. "Natural" sugars are briefly discussed and the "natural sugar" content of several foods is listed. However, differences are not clearly explained; the fact that five of the seven "natural sugar" dairy products also contain added sugar is confusing. Clearly, the scoreboard is designed for the lay consumer rather than the health professional; the division of sugars is accurate but sometimes imprecise. Nonetheless, it contains the components to help teach the truth about sugar-its identity and its sources-and to objectively dispel the myth of the "refined sugar monster" which health fad proponents have tried to create. Susan R. Holman, M.S., R.D., Public Health Nutritionist, South End WIC Program, 400 Shawmut Ave., Boston, MA 02118.
WEIGHT MANAGEMENT PROGRAM FOR ADOLESCENTS ~
SHAPEDOW
Join more than 400 other nutrition educators in preventing another generation of obese adults with the help of SHAPEDOWN. The program generates substantial revenue while providing meaningful, effective care to obese adolescents. What's more, SHAPEDOWN is flexible - it can be applied in group sessions or in individual counseling. Controlled field testing indicates that SHAPEDOWN produces longterm improvement in weight, depression, behavior and knowledge. The SHAPEDOWN program was developed at the University of California, San Francisco by a nutritionist with contributions from more than 100 other health professionals.
"The positive and realistic approach of the SHAPEDOWN WORKBOOK and LEADER'S GUIDE is very much needed to deal with the problem of adolescent obesity. The books will be of particular value to those counseling obese adolescents or those conducting classes for groups of obese adolescents." - Journal of the American Dietetic Association "The thoroughness and creativity inherent in the program reveal the author's understanding of both the adolescent age group and the subject of weight control" - Journal of Nutrition Education "An excellent book for the adolescent who wants to take control of a weight problem and for the professional working with overweight young people." - Tufts University Diet & Nutrition Letter '7he approach is very much geared to. adolescent concerns and problems, and is written in language they will understand." - Nutrition & the M.D. 'With a record like that, SHAPEDOWN is one small step toward a healthier America." - Newsweek Magazine "But around the country there is hope. SHAPEDOWN is one program that is turning the corner." - Bryant Gumbel, NBC Today Show
For information contact Balboa Publishing, 101 Larkspur Landing Circle, Larkspur, California 94939, Telephone: 415-461-8884. To order a review copy of the SHAPEDOWN workbook and leader's guide, send to Balboa Publishing a check or purchase order for $27.90 including shipping (California residents add 6% lax).
Assessment of the Iron Nutritional Status of the U.S. Population Based on Data Collected in the Second National Health and Nutrition Examination Survey, 1976-1980. Pilch. S., and F. Senti, eds.• 1984. From Life Sciences Research Office, Federation of American Societies for Experimental Biology, 9650 Rockville Pike. Bethesda, MD 20814. 122 pp. softcover. $12. postpaid. This is a very technical document that can best be used by researchers and by those who plan health surveys. It may also prove useful to policymakers and clinical diagnosticians. The report contains excellent background information on iron storage, iron turnover, and the stages of iron deficiency. The report discusses the relationship of these phenomena to biochemical measures, and provides a good summary on the consequences of iron deficiency. The discussion of the methodology, including limitations. significance of results, sources of error. and interpretation of results, should be particularly useful to researchers and to diagnosticians. For example, in selecting methods to determine the iron status of groups or individuals, it is essential to know that serum ferritin measures the VOLUME 18
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status of iron stores, while mean corpuscular volume (MCV) measures red cell iron levels. These distinctions are important in differentiating between mild and severe iron deficiency. Unfortunately, the report is rather difficult to read, and would possibly have wider appeal if this were not so. The report also contains some inconsistencies. For example, in one section the statement is made that the number of black subjects included in the survey was too small for the reliable determination of the prevalence of low hemoglobin concentration, but in another section, there is a statement that blacks tended to have a higher prevalence of abnormal values for iron status indicators than did whites. The report offers four recommendations for additional analyses on the NHANES data. However, the rationale for such analyses is not self-evident, and it is not discussed. On the other hand, recommendations for future surveys are well stated. The report also documents shortcomings in earlier surveys and suggests changes that should be made to correct these shortcomings. Overall, the report contains valuable information, but only for a very limited audience. Gwendolyn Washington PIa. Ph.D., Assistant Professor. Howard University, College of Dentistry, Washington. DC 20059. WORKBOOKS
Building Nutrition Counseling Skills, National Institutes of Health, 1984. From U.S. Government Printing Office, Washington, DC 20402; vol. 1: A Guidebook for Workshop Planning, 37 pp., softcover, spiralbound, SIN: 017043-00108-7, $3.75; vol. 2: Workshop Resource Manual, 236 pp., softcover, spiralbound, SIN: 017-043-00107-9, $8.50.
The heart of practicing nutritionists' work lies in skillful and sound personcentered nutrition counseling. To this end. these two manuals from NIH are welcome additions to help practitioners build the personal skills required to meet current health-care needs. The authors call counseling skills "people skills" because these skills are used to help people make positive
health-behavior changes. Counseling is a dynamic process involving many psychosocial elements, interviewing skills, active listening, and. at times. wise use of confrontation. The manuals cover a broad range of topics related to both process and skills development. as well as multiple applications in general practice. The authors' goal is to assist nutrition educators and practitioners in planning and implementing workshops in nutrition counseling. I also find the material helpful in daily work with individual patients and clients. The format makes the material easily accessible. I especially liked the Learning Experience Descriptions (LEDs), a veritable catalog of nutrition counseling activities. All of these LEDs are based on tested activities from the developmental projects for this work at the University of Iowa and the University of Pittsburgh. The writers' collaborative achievement is reflected in a recent award that the sponsoring agency-the National Heart, Lung, and Blood Institute of NIH-received from the National Association of Government Communicators' 1985 Blue Pencil Contest in the category of technical or professional publications. The strengths of these manuals lie in the soundness of their information and their multiple applications for use in practice. I find only one personal annoyance-the use of the term "compliance," a vestige of the traditional authoritative medical model, strangely out of place in this context of personcentered care based on behavioral selfcare change. I prefer the term "adherence." a term that the authors have used elsewhere. Because of their quality and scope, I recommend the use of these manuals on two levels. Certainly they are excellent guides as the authors intend for organizers of nutrition counseling workshops. But I also find here much sound and realistic material that can be used by practicing nutritionists and dietitians in their daily work with clients and patients who are taking steps toward positive health behavior changes. Sue Rodwell Williams, Ph.D.. M.P.H., R.D., Private Practitioner and Author. 640 Hilldale Ave.. Berkeley, CA 94708. JOURNAL OF NUTRITION EDUCAnON
39
EDUCATIONAL MATERIALS FILM
The Enigma of Anorexia Nervosa, 1985. From Carle Medical Communications. 510 W. Main St.. Urbana. IL 61801. three parts: part 1: Delusion and Discord, 18 min .• part 2: Clinical Intervention and Rehabilitation, 16 min., part 3: The Battle of Wills, 26 min., complete program: 3/4", VHS. Beta II. $850; each part: $325; 1-week rental of complete program: $135; 3-day rental of any part: $50.
It is estimated that anorexia nervosa affects as many as one in two hundred white females between the ages of twelve and eighteen. Yet many parents. educators, and health professionals are unaware of the early symptoms of the disorder, or of the necessity for professional intervention to address both the malnutrition and the underlying psychological disturbances. Many anorectics require hospitalization at some phase of their treatment; this can be an especially trying time for patient, parents, and hospital staff. This film is therefore a welcome resource for nurses and other health professionals who will deal with hospitalized anorectics. Part one offers background information on the history of anorexia, and includes a thorough discussion of the biopsychosocial factors involved in both anorexia and bulimia. These factors are presented on a continuum of eating disorders; the anorexic constriction is at one extreme and the anorexic bulimic is at the other. Although the American Psychiatric Association's Diagnostic and Statistical Manual (DSMIII) currently lists bulimia as a separate eating disorder, there is at least some evidence for an overlap in the two conditions; and this continuum can be a useful construct for viewing the larger problem of eating disorders in this society. Viewers ofthis segment will need a health/medical background to understand what is a fairly technical presen-
40
JOURNAL OF NUTRITION EDUCATION
tation; later review of the salient points would also be useful. The second part covers clinical intervention in the hospital setting, and includes both assessment and treatment. Specific clinical symptoms of anorexia are detailed for use by nursing personnel. Components of the initial assessment are reviewed, including a complete physical examination, a patient history, and a family history. A nutritionist then presents various options for refeeding patients, including situations that require naso-gastric tubes or total parenteral nutrition. Careful refeeding is necessary to prepare patients for psychotherapy and to counter the toxic effects of malnutrition, while avoiding both the physiological and psychological damage of refeeding too rapidly. Part two focuses on the team approach to patient management and the key role of skilled nursing care for recovery. Part three covers specific areas in the care of the anorectic patient through a case study presentation interspersed with comments from the nursing consultant for the film. This is an excellent approach for conveying the attitudes of both the patient and the staff, and for portraying the anorectic's skill at manipulating adults in her environment, and 'sabotaging their efforts to refeed her. Although targeted to hospital personnel, this film would be appropriate for a wide range of professionals, particularly those who interact with adolescents and young women and who are in a position to promote early diagnosis and treatment of anorexia. The film is an excellent review for nutritionists and dietitians, and could also be used effectively in training courses for physicians. nurses, dietitians, and students in allied health fields. Some users would benefit from access to a study guide, as the film does cover a fair amount of technical material. GUIDE
Guide to Mass Media and Support Materials for Nutrition Education in Developing Countries, Griffiths, M., et aI., 1985. From International Nutrition Communication Service, Educational Development Center, 55 Chapel St., Newton, MA 02160,128 pp., softcover, $10 prepaid, free to developing countries. Nutrition educators working in developing countries are always looking for new and effective approaches. Frequently, money and time have been lost
because projects have been initiated without the proper "know-how." This book provides some refreshing directions to prepare educators for new projects. This guide provides an overview of the communications approach to nutrition education and focuses on how to use mass media and support materials to get the message across. After reviewing some 300 educational materials, the authors extracted and presented some of the most successful ones along with guidelines for their effective adaptation for use in other situations. The book begins with a description of the five major elements in the art and science of developing nutrition education materials-identifying the nutritional and educational priorities and goals; involving the target group in the development process; following message and materials design principles; designing materials in line with an overall media strategy; and field testing with the target audience. Also included at the outset is a section on how to use the guide as well as a glossary of communications terminology. The major portion of the guide is devoted to reviews of successful nutrition education projects undertaken in various developing countries around the world. The authors reviewed and presented projects under the following major headings: nutrition for the family, maternal nutrition, young child feeding, growth and monitoring, and nutrition-related health problems. Clearly reproduced photographs of the materials are presented along with reviews. A useful organizational feature is that the user gets to see several approaches to a single problem (e.g., weaning) and, therefore, is able to see at a glance how various administrations have handled a particular problem. As a nutrition educator in Jamaica, I was pleased to see that representative materials from my country were included. I am sure that readers in other developing countries will find the same completeness. Nutrition educators will appreciate the pull-out Nutrition Education Game, which will prove useful for programme planning and evaluation exercises. I also recommend this game as a useful teaching tool for in-service training programmes. Also valuable is the inclusion of contacts (with addresses) where readers can obtain copies of materials they wish to use. Although designed primarily for nutrition educators in developing counVOLUME 18
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EDUCATIONAL MATERIALS tries. the guide would be valuable in any training programme that focuses on public health nutrition. It is an excellent reference for developing nutrition education materials and should be a useful addition to the libraries of nutrition educators. especially in developing countries, Pauline M. Samuda, B.Ed., Nutritionist, Manchester Health Dept., Mandeville Post Office, Jamaica, West Indies. MONOGRAPH
New Developments in Nutrition Education, Nutrition Education Series Issue 11. Turner. S. and R. Ingle. eds., 1985. From UNESCO. 7 Place de Fontenoy. 75700. Paris, France, 232 pp .• softcover. free. What do children in India. New Caledonia, the Netherlands. Israel. and Brazil have in common? They have all been involved in nutrition education projects that are discussed in this monograph. A conference. sponsored by the science education department of the University of London Institute of Education and UNESCO. was held in July 1983 to discuss new developments in nutrition education. Topics discussed included: 1) training and educational methods used in primary and secondary schools; 2) programs for improving pre- and in-service teacher training; 3) effective use of mass media to support educational efforts; 4) coordination of government agencies and development of food and nutrition education policies; and 5) development of programs to assess and evaluate teaching and learning programs. The theme reflected throughout this monograph is that effective nutrition education involves having a good knowledge of a community-its needs. problems. and priorities-and using this knowledge to design educational programs of practical significance to its people. In general. a multidisciplinary approach and recognition of environmental and socioeconomic factors that influence eating behavior were important to the design of educational programs that changed attitudes and knowledge. and positively altered eating behavior. This monograph will be of interest to all nutrition educators. especially those in the United States. It provides a rare opportunity to learn about nutrition education efforts taking place in other developed countries as well as in developing countries in Africa. South America. Europe. and the Far East. VOLUME 18
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Pamela Ching, M.S., R.D., Pediatric Clinical Nutritionist, Dept. of Nutrition, The Johns Hopkins Hospital. 600 North Wolfe St., Baltimore, MD 21205.
RESOURCE MANUAL
Nutrition for the Elderly, Rosovski, S., and M. Nelson. 1985. From Brookdale Institute on Aging. Columbia University. 622 West 113th St.. New York. NY 10025, 64 pp., softcover. spiralbound. $6.95. This manual is one of a series of resource manuals planned by the Brookdale Institute on Aging to meet the educational needs of individuals in the fields of gerontology and geriatrics. This publication is specifically intended for those persons concerned with proper nutrition of elderly individuals. The manual is divided into two sections and has sixteen tables and four figures. The first section discusses current theories and research findings concerning nutrition and aging and delineates what this research suggests. The coverage of the field is succinct. . complete. up-to-date. and easy to understand. In particular. the discussions about fiber. vitamins. and minerals are well done. and the tables on drug-nutrient interactions and "non-vitamins" nonessential to health are helpful for easy reference. Using the dietary recommendations resulting from the cited research. in section two the authors provide-by means of extensive tables and sample menus-practical guidelines for feeding elderly individuals. In addition. throughout the section great care is taken to stipulate how certain factors such as individual health status. physical disabilities. personal preference. and behavior may necessitate modification of general guidelines to adequately meet an elderly person's specific needs. In summary. the manual is well written, readable. and a good source of basic material on nutrition for elderly persons. It should be a useful resource for health professionals and educators. human service providers. consumers. and students. as well as for senior citizens interested in maintaining their well-being through proper nutrition. Gertrude C. Kokkonen, B.A .. Chemist, Gerontology Research Center, Francis Scott Key Medical Center. Baltimore. MD 21224.
REPORT
The Reexamination of the GRAS Status of SuIfiting Agents. Life Sciences Research Office. Federation of American Societies for Experimental Biology. 1985. From FASEB Special Publications Office, 9650 Rockville Pike. Bethesda, MD 20814, 96 pp .. softcover, $12. Given a relatively clean bill of health in 1976 by the Select Committee on GRAS Substances. sulfiting agents have since been reported to cause adverse. sometimes life-threatening reactions in sensitive individuals. This technical report, commissioned by the FDA. thoroughly reexamines the safety of the sulfiting agent group of food additives (potassium bisulfite. potassium metabisulfite. sodium bisulfite, sodium metabisulfite, sodium sulfite, and sulfur dioxide). These additives act as antioxidants. help to prevent browning. and serve various other purposes in food. Supported by over 150 specific references. the report reviews available evidence on consumer exposure data. biological studies. and sulfite-sensitivity reactions. Sulfiting agents have not been found to be teratogenic. carcinogenic. or mutagenic in animals. At present, estimated average sulfite consumption is about the same as reported in 1976. and the current report agrees with the 1976 recommendations on safe levels to avoid chronic toxicity. There have been two major developments since 1976: the widespread use of sulfiting agents to preserve freshness in raw fruit and vegetable salad ingredients. and the recognition of bronchial hyperreactivity reactions in a small percentage of asthmatic patients following modest doses of sulfiting agents. The report formally affirms the safety of sulfiting agents for the general public but declares the possibility of severe hazard for those who are sulfite-sensitive. Moreover. the report notes that new labeling requirements will not be adequate to protect sulfite-sensitive individuals, and suggests that curtailment of sulfite use on fresh fruits and vegetables should be encouraged by the regulatory process. Acting on the findings of the report. the FDA, in August 1985. proposed a ban on such uses. This authoritative report is already influencing regulation of sulfiting agents. and is a valuable reference for research libraries and specialists in food science and public policy. What is lacking is a thorough but concise execJOURNAL OF NUTRITION EDUCATION
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EDUCATIONAL MATERIALS utive summary that could have helped the nutrition educator interpret these findings for the general public. Kathleen M. Koehler, Ph.D., Assistant Professor, Dept. of Family Studies, University of New Mexico, Albuquerque, NM 87131.
r-----
CLASSROOM - - - - , SOFTWARE (1-ADULT)
Food for Thought, Marshware, 1985. From Marshfilm Enterprises, Inc., Box 8082, Shawnee Mission, KS 66208, available for Apple II, disk with documentation, $39.95. Also available: You Are What You Eat, 1985, available for Apple II, disk with documentation, $39.95. Can microcomputers teach nutrition concepts? That is what these two software packages attempt, using different approaches. Since the software was designed to be appropriate for learners aged seven through adult, I recruited a seven-year-old first-grader to assist in this review. Both packages were evaluated using an Apple lIe microcomputer with a monochrome monitor. Color monitors can be used but are not essential. The Food for Thought package uses a tutorial approach to promote knowledge of the Basic Five Food Groupsthe foods included in each group, and their nutritional contribution to the diet. My seven-year-old co-reviewer enjoyed using the program, and it did motivate him to learn about his diet. However, I was concerned that much of the information was oversimplified and thus misrepresented nutrition facts. Examples include statements such as "sugary foods provide you with a quick burst of energy" and "carrots may help you see better at night." The program includes a built-in teacher management system to keep records of pupil performance on a randomly generated 20-question quiz. Overall, however, this package has poor design features. For example, there is too much text on the screen per frame, the vocabulary is too sophisticated for some young users, and illustrations are ineffective and contribute little to motivating the user. Also, because the program lacks printout capabilities, hard copy cannot be generated for handout purposes. Based on cost, oversimplified content, and ineffective 42
JOURNAL OF NUTRITION EDUCAnON
design features I cannot recommend this program. The second program, You Are What You Eat, uses the Basic Five Food Groups as a basis for evaluating diets. The program allows pupils to make entries from a list of foods eaten during a day, and the computer, which addresses the pupils by their first names analyzes the diets. The analyses indicate whether the students meet, exceed, or fail to meet the recommended intake for each food group. One of the program's shortcomings is that although it is designed for ages seven through adult, a single set of criteria is used to evaluate the diet of all age groups. Another major flaw is that no recommendations are made to suggest dietary improvements when targets are not met or when fat and sugars are used too liberally. Therefore, the relationship between good eating habits and health, a major educational objective of the program, is not addressed. A final flaw is that portion sizes are not listed for the foods. However, three features redeem this program: 1) printouts of the analysis can be generated for further study; 2) foods can be added to the food lists; and 3) the program stimulated interest in nutrition on the part of my seven-yearold co-reviewer. Notwithstanding, the cost and the fact that the diskettes cannot be duplicated for back-ups may limit classroom utility. A final word of caution: Since many software companies do not permit previews of their products, it is important for potential buyers to find out prior to purchasing a software package whether a nutritionist/programmer was involved in· developing the package. The development of good educational software is still in the early stages and, in nutrition, we have a long way to go. John Orta, R.D., M.S., M.S. Ed., Ed. M., M.A., Associate Professor and Chairperson, Dept. of Nutrition and Dietetics, Pratt Institute, Brooklyn, NY 11205.
becomes a personalized story of a child's health history. It begins with information on the child's prenatal period and birth data and moves into growth and development, immunization history, feelings and socialization, and finally the establishment of good health habits. Interspersed throughout are statements and workbook tasks aimed at enhancing a child's self-concept as well as implanting good health habits. While I find the goal of this book admirable, I have problems with its style and content. The rabbit illustrations are poorly drawn and are used inappropriately to represent young children. Why not show children hugging and children wearing seat belts instead of rabbits performing these activities? The book's hand-lettered style (which looks like pen over words outlined in pencil) is distracting and looks unprofessional. The health concepts in this book deserve more attention than they receive. There is scant coverage of personal safety and the prevention of accidents, dental health and the prevention of sexual abuse are virtually ignored, and the nutrition section consists of pictures of foods to be cut and pasted under headings for each of the Four Food Groups. From my experience with preschoolers, I believe they are ready for and interested in much more sophisticated nutrition education techniques than cutting and pasting. While this workbook idea may have some usefulness in the home setting for parents and their children, I do not recommend it for use in preschool settings. Sensitive teachers and a comprehensive curriculum that includes basic health information will accomplish much more in establishing good health habits in children. Kari Ostheller, R.D., M.P.H., Nutritionist with Daycare, W.I.G., M.C.H., Seattle-King County Health Dept., 1406 Public Safety Bldg., Seattle, WA 98104.
WORKBOOK (P)
Nutrition Express, Jacobson, M., and D. Riggs, 1985. From Center for Science in the Public Interest, 1501 16th St., NW, Washington, DC 20036, available for Apple II, floppy disk, Nutrition Scoreborad poster, $39.95 prepaid. What would you buy a friend with a fistful of fodars? This is the question facing players of this program. Players have the opportunity to answer questions about foods and nutrition and re-
SOFTWARE (4-8)
Healthy Happy Me, Calkins, H., 1984. From Resources for Children, Youth and Families, Box 1469, Scottsbluff, NE 69361, 40 pp., softcover, $4.25. Looking like a distant relative of Bugs Bunny, "Habit Rabbit" is the central character in this preschool health book. This workbook is intended to be completed with the cooperation of parents, teachers, and the preschool child and
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EDUCATIONAL MATERIALS view clues to future questions. Correctly answered questions earn points, called fodars, that are later exchanged for foods at the game's supermarket. During the game, players are given the chance to exchange foods between food groups to improve the nutritional quality of their chosen diet and their final score. Nutrition topics include sodium, cholesterol, caloric content of foods, fat, calcium, and sugar. Foods purchased with earned fodars are rated according to food category and the nutritional value assigned to each food. A player's final score depends on the balance of foods selected and the nutritional value of the foods. The game is over when the player reaches "FodaFoda Headquarters." Then the player's food selections are scored, and the final score is given in terms of the number of FodaFodas (natives of FodaFoda) the player may take home. A summary of the number of correct and incorrect answers given by the player during the game is also provided. Designed for middle school and junior-high school students, age nine years and older, the questions are written at an appropriate reading level. Also, the content of questions is technically correct. Menu driven, the game provides written instructions on the screen with help screens available during the game. The database contains a limited number of foods to select from during the game. Citrus fruits are an obvious omission. Also, ethnic foods and more commonly eaten foods are not included. Iron-rich foods such as liver and red meats are either omitted or are given lower nutrient scores. Although the branching of the program can help retain student interest, and sharpen problem-solving skills, it may prove confusing to some students in that the method of play can become tedious. For example, a skilled player may move rapidly through all major locations, answering questions correctly, and then become trapped within the game due to limited opportunities given to reach "FodaFoda Headquarters." Once questions are answered at a location, there are no additional points to be gained by a player returning to that location, and travel between locations costs the player points. Thus, a skilled player may lose points moving from location to location (in search of the headquarters) while trying to end the game. The complexity of the point system, moving between locations, and VOLUME 18
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exiting the game may be too difficult for younger students, depending on their ability to analyze and solve problems. Since classroom activities and discussion questions are well written, they should stimulate students' interest in general nutrition and help students to analyze their personal nutritional habits. The limited number and types of foods combined with the complexity of the game, indicate that the software is not a stand-alone nutrition unit. Further instruction is necessary to provide students with a more complete understanding of nutrition as it relates to their lifestyle and current situation. The program may be best used as an introduction to timely topics in nutrition or as a review of information. Mary Helen Mays, Ph.D., R.D.lL.D., Nutrition Consultant, 5401 14th St., Lubbock, TX, 79416. WORKBOOK/HANDBOOK (4-9)
You're SomeBODY: How to be a slim kid, Corby, L., and P. Clark, 1985. From Fifth House Publishers, Ltd., 406 Clarence Ave. S., Saskatoon, Saskatchewan S7H 2C7, Canada, 122 pp., softcover, spiralbound. Also available: SomeBODY's Companion, 44 pp., softcover, $18.95 for the set.
ture an overweight child while learning how to help the child improve activity and nutrition habits. The books were developed for use in Canada and therefore contain the Canadian Food Guide and list professional resources available in Canada. However, the books could easily be adapted for use in the United States. Although a minimum age of nine is mentioned, it is not entirely clear what age group this set of materials is appropriate for. By selecting specific sections according to reading level, the child's workbook could be used for boys and girls age nine to fourteen. The parent's volume would be improved by adding more information about growth and development and normal fat patterning in growing children, but this information could be provided by a workshop leader who would guide parents in the use of this handbook. I highly recommend this set of materials to professionals as a resource for activities when treating childhood obesity in a clinic or workshop setting, and to parents who want to learn more about promoting good health habits in their children. Ruth W. Crocker, R.D., M.Ed., Family Consultant, Children's Weight Control Program, The Children's Hospital, Fegan 6, 300 Longwood Ave., Boston, MA 02115.
CONSUMER EDUCATION ] ~----- AND COUNSELING
[
MANUAL
At last! A creative and factual approach to childhood obesity designed for parents and children. This set contains a workbook for children and a separate handbook for parents. The children's workbook focuses on learning experiences designed to improve selfimage, increase physical activity, and promote sound food habits. The parent's handbook is packed with information and learning activities that will help parents or other concerned adults (companions) to understand and nur-
Diabetes Mellitus: A manual for patients, Pearson, J., 1983. From Diabetes Education Center, Mercy Hospital of Watertown, 218 Stone St., Watertown, NY 13601, 236 pp., softcover, spiralbound, $6 plus $1.50 postage. Most diabetes educators are probably familiar with the image of a diabetic patient leaving the office clutching a handful of pamphlets, handouts, Xeroxed sheets, and written notes that attempt to explain diabetes, exchange lists, the client's diet and so on. This manual on diabetes mellitus is therefore a welcome solution to this problem, providing in one spiralbound volume a complete, clearly written handbook for those who have diabetes. The manual is divided into colorcoded sections for easy reference and the typeface is larger and easier to read JOURNAL OF NUTRITION EDUCATION
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EDUCATIONAL MATERIALS
DIABETES MELUTUS
than that found in most educational pamphlets. Topics covered include an overview of diabetes, keeping in control, medication, uncontrolled diabetes, personal hygiene, and special situations. The manual also contains a glossary and reference section with information on cookbooks and magazines of interest to those with diabetes. The diet section is exceptionally complete, with exchange lists for ethnic foods, alcoholic beverages, fast foods, and prepared foods. The manual also includes recipes, and there is information on calculating food exchanges from labels-although this process is somewhat complicated and may be of more use to the diabetes educator than to the patient. Other sections of particular interest, often overlooked in diabetes education materials, address the psychological aspects of diabetes and issues relating to sexuality and pregnancy. Two minor criticisms of the manual: The quality of the graphics is very poor and detracts from the overall appearance of the manual, and the pages are not numbered, an omission that would be particularly annoying if the manual were used in a group teaching setting. Both problems could easily be remedied, however, in a future edition of the manual. This manual is a complete, low-cost diabetes education reference for health professionals and should be an integral part of every diabetic education program. Susan Greathouse, M.P.H., R.D., Nutrition Instructor, EFNEP, U.C. Cooperative Extension, 100 37th St., Room 117, Richmond, CA 94805. HANDBOOK
Diet and Diabetes, Patient Handbook 21, Thomas, B., 1984. From Churchill Livingstone Inc., 1560 Broadway, New York, NY 10036, 97 pp., softcover, $3.50. In short, incisive chapters this book reassures apprehensive, newly diagnosed diabetic adults and parents of diabetic children. A typically British "let's get on with it" approach explains 44
JOURNAL OF NUTRITION EDUCATION
how to adapt new dietary restrictions into present lifestyles. If there is a fault in this otherwise easily read and understood handbook, it is that the author uses British food terminology, which will be unfamiliar to most American readers. The diabetic foods mentioned do have counterparts in our supermarkets, but no reference is made to them. The author is also more lenient in his recommendation of the use of alcohol by diabetics than is the American Diabetes Association. In addition he favors the use of candy rather than fruit as a source of quick energy. However, he does debunk old myths that suggest diabetes is caused by eating too much sugar, and encourages adapting family meal plans to the new circumstances. Illustrations of menu adaptations, tables of the carbohydrate values of different foods, and recipes for patients who have diabetes are included as well as special hints for traveling, eating out, illness and holidays. A low-fat diet is recommended, not only to avoid obesity but also to avoid the heart disease complications that persons who have diabetes are prone to. However, the author does not differentiate between the use of saturated and unsaturated fats. They. are lumped together and some confusion is bound to result. Despite the weaknesses that I have pointed out, this handbook gives a straightforward account of a very complicated disease. The book is sure to give diabetic patients confidence in their ability to cope with the disease, and I do not hesitate to recommend it. Marianne Rosen, R.D., M.A., Private Practice, 68 Sprain Valley Rd., Scarsdale, NY 10583. BOOKLET
A Gift of Love: Breast feeding, American Academy of Pediatrics, 1984. From American Academy of Pediatrics, Publications Dept., Box 927, Elk Grove Village, IL 60007, 24 pp. booklet, $1.25, bulk rates available. As the number of mothers who are breastfeeding their infants increases so does the need for practical, easy-to-understand, accurate information to educate those mothers and answer their questions. This booklet successfully meets this need. Written for mothers, health professionals who care for mothers and babies, and those who want to encourage breastfeeding, this booklet discusses old wives' tales, where to get help for
problems with breastfeeding, and frequently asked questions about breastfeeding and weaning. It also includes a daily food guide (with information about nutritional needs) for nursing women and provides valuable tips on how to begin breastfeeding, how to continue nursing if you work outside the home, and how to recognize common breastfeeding problems. Because the booklet offers clear explanations and avoids jargon, individuals with little or no knowledge about breastfeeding will have access to basic and in-depth information. The question-and-answer portion is especially valuable due to the prevalence of myths and misinformation surrounding breastfeeding. The booklet's size, length, format, and graphics will also add to the enjoyment of the reader. The food guide, which is an insert in the middle of the publication, lists suggested servings of food based on a variety of food groups. Although food groups are used in designing adequate nutrient intake, creating meals based on this system may be difficult for some women with little or no nutrition knowledge. Including sample meals or menus would have made this section more meaningful to the reader. As a dietitian, I found this booklet a valuable resource, which I will recommend to mothers as well as to other health professionals. As a mother of two breastfed children, I especially appreciated the candid and caring approach to the subject of breastfeeding. This resource is excellent and should help dissipate fears and anxiety about breastfeeding. Felice D. Kurtzman, M.P.H., R.D., Senior Dietitian, Student Health Service, University of California, Los Angeles, Los Angeles, CA, 90024. DIET PLAN
Heart Smart: A plan for low-cholesterolliving, Becker, G., 1985. From Simon & Schuster, 1230 Avenue of the Americas, New York, NY 10020, 192 pp., softcover, $5.95. One of the greatest challenges faced by anyone attempting a reduced cholesterol and saturated fat diet is to plan food intake in accordance with the suggested percentages of macronutrients and various types of fat. The author has developed an inventive exchange system with seven food groups that does this for the reader. The book begins with a brief discussion of the theory behind the development of atheroscleroVOLUME 18
NUMBER 1
1986
EDUCATIONAL MATERIALS sis and a summary of behavior modification techniques for changing eating and exercise habits. It also contains recipe modification tips, shopping suggestions, low-cholesterol food substitutions, and hints for eating on special occasions. The final section of the book contains over one hundred recipes, including nutrient analyses. Both the strengths and weaknesses of this book lie in its simplicity. The author's use of analogies, graphs, drawings, and an excellent recipe index make most topics presented easy to comprehend. However, some areas are dealt with so briefly that I doubt whether the average layperson will understand, let alone master them. For example, only 1600- and 2000-calorie diet patterns are presented. The reader is told to use a ratio based on his or her own calorie needs to calculate an individualized pattern. Because this method often leads to fractions of food groups, it will undoubtedly be confusing to the reader: What does one do with one-fourth of a grain exchange? Also, although ideas for modifying recipes are given, the information necessary to incorporate these ideas into the exchange system is not provided. These and similar limitations could
lead to reader frustration and noncompliance. Overall, the strengths of this book outweigh its weaknesses. It is suitable as a beginning reference for patients who have to lose weight as well as reduce serum cholesterol. However, it should only be used under the supervision of a registered dietitian who can explain and individualize the diet plan. Barbara J. Visocan, M.S., R.D., Chief Clinical Dietitian, Dept. of Food and Nutrition Services, Hahnemann University Hospital, Broad and Vine Streets, Philadelphia, PA 19102. POSTER
Sugar Scoreboard, Center for Science in the Public Interest, 1985. From CSPI, 1501 16th St. NW, Washington, DC 20036, 18" x 24" wallchart, $3.80 each or $7.30 each laminated, bulk prices available. This colorful wallchart is a clear and provocative educational tool that will initiate lively discussion about the sugars manufacturers add to processed foods. The scoreboard lists over 200 convenience and snack foods and, for each, the percentage of calories from added sugar. The number of teaspoons of sugar per serving is graphically sym-
bolized by small black squares which, lined up in ascending order, make a strong visual statement. Sandwiched between the lists is concise, objective information: a discussion of the controversies and potential health risks of a high-sugar diet, definitions of common commercial and natural sugars and artificial sweeteners, and suggestions for decreasing dietary sugar and minimizing tooth decay. "Natural" sugars are briefly discussed and the "natural sugar" content of several foods is listed. However, differences are not clearly explained; the fact that five of the seven "natural sugar" dairy products also contain added sugar is confusing. Clearly, the scoreboard is designed for the lay consumer rather than the health professional; the division of sugars is accurate but sometimes imprecise. Nonetheless, it contains the components to help teach the truth about sugar-its identity and its sources-and to objectively dispel the myth of the "refined sugar monster" which health fad proponents have tried to create. Susan R. Holman, M.S., R.D., Public Health Nutritionist, South End WIC Program, 400 Shawmut Ave., Boston, MA 02118.
WEIGHT MANAGEMENT PROGRAM FOR ADOLESCENTS ~
SHAPEDOW
Join more than 400 other nutrition educators in preventing another generation of obese adults with the help of SHAPEDOWN. The program generates substantial revenue while providing meaningful, effective care to obese adolescents. What's more, SHAPEDOWN is flexible - it can be applied in group sessions or in individual counseling. Controlled field testing indicates that SHAPEDOWN produces longterm improvement in weight, depression, behavior and knowledge. The SHAPEDOWN program was developed at the University of California, San Francisco by a nutritionist with contributions from more than 100 other health professionals.
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