1. Structured Diet Versus Plate Method
Pinky Rose Viloria, RND Kristia Lei Reyes, RND
PhilSPEN October 23, 2013

2. Outline Definitions Examples of Structured Diet
Examples of Plate Methods
Advantages of Both Methods
Summary
Conclusion

3. Structured Diet
Is a calculated diet based on the Food Exchange List (FEL) used by Dietitians
Used specifically for meal planning
“structured” means:
Food list/food groups
Number of exchanges per group
With distributions for the Meals and snacks of the day

4. Example of Structured Diet:
Diet Prescription: 1500 kcal,
Food Exchanges
No. Of Exchanges
Sample Menu
Approximate Size per Serving
Breakfast
Fruit
Meat/Substitute
Rice/Substitute
Milk (for Coffee)
Sugar 1 2
Ripe Papaya
Baked Ham Sausage
Pan Amerikano
Evaporated Milk
White Sugar
1 slice (10x6x2cm)
3 (9cm dia x 0.3cm thick)
2 slices
2 Tablespoons
2 teaspoons
Mid-A.M. Snack
Meat
Pan de Limon
Cottage Cheese
1 piece (6x5x4 cm)
1/3 cup

6. Plate Method Based on the latest USDA Dietary Guidelines
Consists of a 9-inch plate
Plate is divided like pie chart, divided into portions of important food groups
Uses different colors or pictures of foods

7. The Plate Model: A Visual Method of Teaching Meal Planning
A simple alternative to the traditional exchange-based method for teaching meal planning
serves as a pie chart to show proportions of the plate that should be covered by various food groups
Dietitians from Canada, Finland, France, and Sweden have explored methods of teaching meal planning to persons with diabetes and dyslipidaemias in the Diabetes Atherosclerosis Intervention Study. The Plate Model, a method commonly used in Europe, is a simple alternative to the traditional exchange-based method for teaching meal planning. In this visual method, a dinner plate serves as a pie chart to show proportions of the plate that should be covered by various food groups. Portions of foods and appropriate food choices can be depicted for meals and snacks in assorted forms of the model. Methods of presenting the model range from professional photography to hand-drawn sketches and displays of food replicas
Camelon, Kathryn et. al. J Am Diet Assoc. 1998; 98:1155–1158.

8. The Plate Method is an Effective Education Tool for Overweight Adolescents
Objective: To determine if the Plate Method of nutrition education is an effective approach to teach overweight year-old adolescents (BMI > 95th percentile) in West Virginia to choose healthier foods
Result: subjects have increased servings of fruits, vegetables, and whole grains, while servings of soda/sweetened drinks and high fat/sugar foods have decreased.
Conclusion: Using the Plate Method as a nutrition education tool is an effective way to help overweight adolescents make healthier food choices at meal-time(s)
The number of overweight adolescents in the United States continues to increase and effective methods of treatment intervention need to be established. The objective of this study was to determine if the Plate Method of nutrition education is an effective approach to teach overweight year-old adolescents (BMI > 95th percentile) in West Virginia to choose healthier foods. Twenty-four adolescents were recruited through schools, physician's offices, and community programs to attend a two-week residential lifestyle-modification camp with three follow-up weekends over the next 12 months. Prior to attending the initial camp session, subjects were asked to complete a three-day diet record. Three-months later subjects were asked to complete a three-day diet record before coming to the first follow-up weekend. While attending the camp session, subjects participated in four, 50 minute nutrition education lessons focusing on the Plate Method and 'Always' food choices vs. 'Sometimes' or 'Sparing' food choices. Twenty-three subjects participated in the two-week camp session and 19 subjects attended the first follow-up session. Diet records prior to camp indicated that on average subjects were not meeting recommendations for servings of fruits, vegetables, milk, or whole grains, but were exceeding recommendations for soda/sweetened drinks and high fat/sugar foods. Diet records at follow-up indicate that on average subjects have increased servings of fruits, vegetables, and whole grains, while servings of soda/sweetened drinks and high fat/sugar foods have decreased. Using the Plate Method as a nutrition education tool is an effective way to help overweight adolescents make healthier food choices at meal-time(s).
Schoeppner, Heidi et. al. The Journal of the Federation of American Societies for Experimental Biologies

9. The Healthy Diabetes Plate
The Healthy Diabetes Plate, which used the plate format to teach individuals about the type and amount of foods they should consume at each meal (by the University of Idaho)
In 2004, the four-lesson curriculum was taught in three urban and five rural counties
Participants were able to correctly plan breakfast, lunch, and dinner meals and improved their intake of fruit and vegetables.
Background
Diabetes education presents two major challenges to the U.S. Cooperative Extension System. The first is that the majority of diabetes education services are provided in more populated areas, resulting in large nonurban areas being underserved. The second is that many individuals with diabetes find the meal-planning component of diabetes education confusing.
Context
The University of Idaho, a land-grant institution, includes teaching, research, and extension as part of its mission. Extension means "reaching out," and in Idaho, the Extension Service provides research-based programs on agricultural, natural resources, youth, family, community, and environmental issues in 42 of Idaho's 44 counties, making it accessible to most Idahoans.
Methods
The University of Idaho Extension Service collaborated with dietitians and certified diabetes educators to develop and test materials that simplify the meal-planning component of diabetes education. The result was a four-lesson curriculum, The Healthy Diabetes Plate, which used the plate format to teach individuals about the type and amount of foods they should consume at each meal. In 2004, the four-lesson curriculum was taught in three urban and five rural counties. Surveys, hands-on activities, and note-taking of participants' comments were used to collect data on participants' characteristics, their ability to plan meals, and changes in eating habits.
Consequences
Participants were able to correctly plan breakfast, lunch, and dinner meals and improved their intake of fruit and vegetables.
Interpretation
Quantitative and qualitative evaluation information gathered from class participants helped identify which components of The Healthy Diabetes Plate curriculum were effective.
Raidl, Martha et. al. Prev Chronic Dis January; 4(1): A12. Published online 2006 December 15. PMCID: PMC

10. How to do it

11. Step 1
Take an average sized dinner plate and divide it in half. In one half place non-starchy vegetables such as:
Spinach, Broccoli, Cauliflower, Romaine lettuce, Cabbage, Carrots, Tomatoes, Onions, Cucumber, Beets, Peppers
About one cup of raw vegetables is considered an appropriate serving size.
One cup would be about the size of your fist.

12. Step 2
Divide the other half of your plate in half again. In one quarter place your protein source, such as:
3 oz. of lean beef or pork
3 oz. of skinless turkey, chicken or fish
Tofu
Eggs
Cottage cheese
A 3 oz. serving is about the size of a deck of cards

13. Step 3
In the other quarter of your plate place your starchy foods such as:
Bread, Potatoes, Corn, Beans, Rice, Tortilla, Cereals, Oatmeal
Serving sizes range from ½ cup of rice to a baked potato about the size of your fist.

14. Different Models
of the Plate Method

15. Harvard Healthy Eating Plate

17. US Department of Agriculture (USDA) MyPlate

18. The Idaho Plate Method works by visualizing how much space each of the major food groups should occupy on one’s plate. At breakfast, one fourth of the plate should have a protein or meat, half of the plate should have a starch, and one-fourth of the plate would be empty. The meal should be completed with a milk, yogurt, or fruit. At lunch and dinner, the plate should show a similar pattern: one fourth of the plate should have a starch, one-fourth should have a protein or a meat source, and half should be filled with low-calorie vegetables (not “starchy” vegetables, such as potatoes, corn, or peas). On the side of the plate there should be either 1 cup of milk or yogurt or a half-cup of pudding or ice cream, as well as one small piece of fruit. Using low calorie seasoning to flavor food, the Plate Method provides approximately 1,200–1,500 calories. This approach is not only easy to use, but also works well when eating outside
the home, such as in a restaurant or at a family gathering.
Idaho Plate

20. UK Eatwell Plate The recommended percentages are:
Fruit and vegetables: 33%
Bread, rice, potatoes, pasta: 33%
Milk and dairy foods: 15%
Meat, fish, eggs, beans (protein) :12%
Foods and drinks high in fat and/or sugar: 7%
The guide recommends that you try to get this balance every day, or over several days or a week. Based on the recommendations you should eat:
Lots of fresh fruit and vegetables (at least five portions every day).
Lots of whole grain rice, potatoes, cereals, bread, pasta and other starchy foods
Small amounts milk and dairy foods (low fat varieties preferred)
Restricted amounts of fish, meat, eggs, beans and other non-dairy proteins
Very small amounts of foods and drinks that are high in sugar and/or fat
Try to choose options that are lower in salt when you can.
Conclusion The Eatwell Plate is a much better image as it conveys a simpler message and gives a better indication of proportions.
UK Eatwell Plate

24. Population /group specific plate models

29. In addition to the Plate graphic itself, the new icon is accompanied by the following nutritional guidelines that offer more information for healthy eating.
Enjoy your food, but eat less.
Avoid oversized portions.
Make half your plate fruits and vegetables.
Make at least half your grains whole grains.
Switch to fat-free or low-fat (1%) milk.
Compare sodium in foods like soup, bread and frozen meals—and choose the foods with lower numbers.
Drink water instead of sugary drinks.

30. Advantages of Structured Diet
More accurate calorie counting
Includes all food groups such as fats/oils, sugar
Time and meal distribution is indicated
Indicates number of servings or exchanges per food group

31. Advantages of Plate Method
Enhancement of the connection between dietary theory and practice
Promotion of memory retention and understanding through visual messages
Experience of a positive approach to nutrition counselling
Various cuisines and festive foods can be incorporated into the model
Offers a meal planning approach that is simple and versatile
Easier to understand
J Am Diet Assoc. 1998; 98:1155–1158.

32. Diabetes Plate Method offers many invaluable benefits to the diabetic people:
1. The blood sugar level of a diabetic individual can be managed under the required level every day since carbohydrates are distributed evenly.
2. The consumption rate of starches, fat or cholesterol can easily be maintained.
3. A diabetic individual will be able to get plenty of fiber, antioxidants, phytochemicals and proteins which forms a healthy diet.
4. Another notable benefit is the weight loss without extra effort. As we know, excess body weight minimizes insulin sensitivity.

33. Recording and Recall

34. Comparative List of High Nutrient and Low Nutrient Foods
High Nutrient Food
Low Nutrient Foods
Whole Grains, Breads, and Rice
Whole grains (wheat, oats, barley)
Whole grain breads, rolls, bagels, crackers and muffins
Whole grain and high-fiber cereals
Whole grain pasta
Brown rice
Croissants
Fried rice
Doughnuts and pastries
Sweet rolls
Cookies
Cakes
Egg noodles and pasta  
Vegetables
Bean Sprouts, broccoli, Brussels sprouts, cabbage, carrots, cauliflower, corn, cucumbers, green beans, leafy vegetables, mushrooms, potatoes, summer and winter squash, tomatoes, sweet potatoes, yams  
French-fried potatoes, fried vegetables
Vegetables packed in sauce
Fruits
All fresh fruits, especially apples, oranges, apricots, bananas, berries, cantaloupe, citrus fruits, peaches, pears
Canned or frozen fruits, unsweetened or packed in water or their own juice  
Canned or frozen fruits, sweetened packed in syrup
Fruit rolls
Fruit drinks

35. Proteins and Protein Substitutes
High Nutrient Food
Low Nutrient Foods
Proteins and Protein Substitutes
Eggs, egg whites, egg beaters, fish, chicken, turkey, round or loin beef, round or loin pork, legumes, tofu, lean luncheon meats, nuts & seeds  
Hot dogs, luncheon meats, sausage, bacon, fried fish, fried poultry, spareribs, prime cuts of meat.
Dairy Products
Nonfat, skim, and 1% milk
Nonfat products such as buttermilk, cottage cheese, and yogurts
Soy milk
Nonfat ice milks and sherbets
Fat Free or low fat cheeses  
Whole milk
Whole milk products such as cheese, cottage cheese, custard, milk shakes, pudding,
and ice cream
Beverages
Water
Herbal teas
Non caloric beverages  
Sugared soft drinks
Alcoholic beverages
Caloric beverages  
Fats
 Vegetable oils (olive oil, canola oil, flaxseed oil, safflower oil)
Fat free sour cream, cream cheese
Nuts and seeds, flaxseed
Avocados, olives, dark chocolate
 Butter, margarine, lard
Cream cheese, sour cream
High fat salad dressings
Cakes, cookies, high fat desserts

37. Variations among healthy diet plans
In Summary…
Variations among healthy diet plans
Most healthy diets are built on the same general principles, but there are key differences that reflect dietary preferences, food availability and cultural eating patterns.
For example, the Latin American Diet Pyramid might mention tortillas and cornmeal, whereas the Asian Diet Pyramid might include noodles and rice.
Other differences include:
1. Food groups
The food groups among healthy-diet plans vary in some ways. For example, some versions have plant-based proteins — soybeans, beans and nuts — in a separate group from animal proteins found in meat, poultry, eggs and dairy products. This is because animal proteins are often higher in fat and cholesterol, and some diets limit or exclude animal proteins.
2. Serving recommendations
Healthy-eating plans also vary in the recommended servings of each food group. The Mayo Clinic Healthy Weight Pyramid, for example, recommends a daily number of servings from each food group. Other plans offer more-general guidelines, such as eating particular foods at every meal, or on a weekly or monthly basis. Or that the Mediterranean Diet Pyramid recommends that you eat whole grains, vegetables and fruits at every meal.

38. The plate method has been used for diabetes meal planning
The plate method has been used for diabetes meal planning. It also works well for weight loss, teaching good nutrition and in improving blood glucose and lipids.
Benefits
Weight loss
Improved carbohydrate distribution
More nutritionally sound diet
Increase intake of fibers
Decrease fat and cholesterol intake

39. Try the Plate method for:
People with busy lifestyle
Seniors
Feeling overwhelmed because of a recent diagnosis or psychological circumstances
Cognitive difficulties / Low literacy level
For those with difficulties in using a more structured approach
Type 2 diabetes and needs to loose weight
“The Plate Method works particularly well for patients who eat three meals a day, are at a low literacy level, have cognitive difficulties, are elderly, have type 2 diabetes and need to lose weight, or are hospitalized and need “survival” information. It also adapts easily for patients who snack by allowing individuals to move side items to snack time. It does not require math skills or a high reading level.” by Brown MD, Lackey HD, Miller TK, Priest D. Controlling calories — the simple approach. Diabetes Spectr 2001;14(2):110-2.

40. Conclusion:
Whatever tool or principle you as a health professional will use, always remember the Basic principles of a healthy diet:
That the diet is appropriate to the needs and condition of the individual .
Symbols/ tools (computed diets, pyramid & the plate) are educational tools to help us visualize and understand the diet better, these tools illustrate how the pieces of a healthy diet fit together.
Definitely, no single food provides all of the nutrients that your body needs, so the idea is to eat a variety of foods from each group in the proper proportions to get all the necessary nutrients and other substances that promote good health.
Lastly , a healthy-diet plan/regimen should emphasize the following:
Eat more plant foods, including fruits, vegetables and whole grains.
Choose lean protein from a variety of sources.
Limit sweets and salt.
Control portion sizes.
Be physically active.
The base of the pyramid is typically made up of foods that should be the bulk of your healthy diet. In contrast, foods you should eat in smaller amounts or less frequently are shown in the smaller sections of the pyramid.
The same principle applies to the dinner plate — half of the plate consists of fruits and vegetables, which should be the bulk of your diet.

41. Putting the pyramid, the computed diet or the plate — to work for you
Know the specific needs of the individuals that needs to be addressed.
To see how your eating habits match up to these healthy-diet plans, keep a food diary for several days. Then compare how much of your diet comes from the various groups.
To eat healthier, start with gradual changes, such as eating more vegetables, fruits and whole grains, and limiting fats and sweets.
Choose a variety of foods
This ensures that you get all of the calories, protein, vitamins, minerals and fiber you need.
Choosing a wide range of foods also helps make your meals and snacks more interesting.
Adapt the plan to your preferences
How to do it?
Explore all possibilities!
Combine foods any way you like but in the right amount
A serving of grains doesn't only mean a slice of bread. It can be wild rice, whole-wheat pasta, grits, bulgur, cornmeal muffins or even popcorn. If you need to avoid milk because of lactose intolerance, try yogurt (lower in lactose) or fortified soy milk instead.

42. Sources
American Dietetic Association. "New MyPlate Is a Useful Tool for Consumers to Follow Dietary Guidelines and Eat Healthfully, Says American Dietetic Association," American Heart Association. "American Heart Association CEO Nancy Brown Says New USDA Food Icon Is A Positive Step Towards Improving Consumer Health," Hellmich, Nanci. "USDA Serves Nutrition Guidelines on 'My Plate'," The Journal of the American Medical Association. "New Nutritional Icon Steps Up to the Plate," Khan, Amina . "USDA to Reshape How We See Dietary Nutrition," Neuman, William. "Nutrition Plate Unveiled, Replacing Food Pyramid," United States Department of Agriculture. "USDA's MyPlate," Vastag, Brian. "At USDA, a Plate Usurps the Food Pyramid,"