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Handout 13.1 ( continued)
15 Ways to Sneak Fruits and Vegetables into your Meals and Snacks
Everyone knows the power of produce. Food fads have come and gone, but fruits and vegetables have held steady at the top of recommended food lists. They are colorful, tasty, versatile, and full of vitamins, minerals and fiber; yet they’re easily overlooked at the grocery store. Here are just a few ways fruits and vegetables can liven up even the most boring dish.
1. Fruit smoothies or juicing
2. Baked potato with vegetable toppings such as beans, salsa, and broccoli 3. Precut vegetables dipped in salad dressing or hummus
4. Apple, banana, or celery with peanut butter or other nut butter
5. Soups with vegetables and/or legumes
6. One-pot entrees with vegetables included such as casseroles, stir fries, pasta, and stews
7. A lettuce- or spinach-based side salad
8. A lettuce- or spinach-based main salad with added chicken, tuna, salmon, bacon, steak, or beans
9. A lettuce-free salad side dish (salad toppings only, mixed with salad dressing) 10. Fresh vegetable such as broccoli or cauliflower, steamed in the microwave, flavored with cheese, butter, salt, and/or other seasonings
11. Add vegetables such as lettuce, tomatoes, avocado, and corn to a burrito, taco, or taco salad
12. Add vegetables to entrees such as sandwiches, wraps, pizza, and omelets 13. Add salsa to anything
14. Add frozen spinach to scrambled eggs, omelets, or quiches
15. Add vegetables into a pasta, rice, or quinoa salad
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as, “How likely are you to prepare this recipe on a scale from 0 to 10, with 0 being not at all likely and 10 being very likely?”
Determine your client’s preference for obtaining recipes. Does he like
using the Internet? Apps? Cookbooks? Or does he prefer to ask a trusted friend? For a client who is faced with a challenge of reducing dietary
sodium, the practitioner may offer strategies for replacing table salt with other seasonings, or refer the client to a website or cookbook with low-sodium meal ideas. It all depends on your client’s preference.
Finally, ask the client how long he prefers to spend preparing and
cleaning up from meals. Recommend recipe ideas that line up with his
availability. For clients who have limited time, consider suggesting one-pot meals to minimize dishes and mixing premade items with fresh items
to save time on preparation. For example, jarred spaghetti sauce may be an important time saver for some clients. Others may rely on prechopped, frozen, or canned vegetables and canned beans. Keeping recipes simple is key in increasing self-efficacy in the kitchen. Clients will be more open to trying new meal ideas if their preferences for taste, texture, and cooking techniques are determined first. Figure 13.1 includes a list of topics that are useful to explore with the client before providing recipe tips and suggestions.
Here are some additional questions that can be used to assess your cli-
ent’s needs for guidance in the kitchen.
“How comfortable are you in the kitchen?”
“How long do you prefer to spend preparing a (breakfast, lunch, din-
ner) meal?”
“Describe your preferred cooking methods. (Do you prefer baking,
boiling, sautéing, microwaving, grilling, etc.?)”
“What are your preferences in terms of taste, texture, and ethnic cui-
sine?”
Before providing suggestions for new meals ideas, determine your client’s:
• Current preferences of tastes and textures.
• Current staple meals.
• Cultural food preferences.
• Preferred time spent in the kitchen.
• Preferred method for finding new recipes.
• Necessary dietary restrictions based on disease state or condition and medications.
• Cooking skil s.
• Budget for food.
FIgure 13.1. Ask before you provide.
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“Describe the meals you know how to make and enjoy making.”
“What flavors, textures, colors, or food groups are you hoping to add
to your meals?”
“How do you prefer to obtain new recipes or meal ideas?”
In the script below the practitioner asks some of these questions and
guides the client toward a behavior change that the she perceives as manageable.
pRactitioneR: You’ve set your own goal of limiting your eating out
to once a week. You’ve figured out a grocery-shopping strategy
that involves going on Friday evenings with a list. [summary] Now
I’m wondering if it would be helpful to talk about what you’re
going to cook. Would you be interested in discussing this piece
further? [focusing and asking permission]
client: Yes, that would be helpful. Like I said, I have a few meals that I know how to make, but I know if I expanded that list, I’d be
more excited to cook at home [change talk—reasons for change].
When I’ve tried in the past to cook at home more, I always felt like
I was eating the same foods over and over again.
pRactitioneR: Eating a variety is important to you. [affirmation]
client: Yes. And since I work, I don’t have a lot of time to create these elaborate meals.
pRactitioneR: So taste is important; you mentioned earlier that cost
is important, and it sounds like time matters too . [summary]
What else is important to you as we figure out the best meals for
cooking at home? [open-ended question]
client: I love Italian and Mexican food, and of course American
comfort foods are good too. I don’t know how to make Chinese
food, but I like it.
pRactitioneR: Great, many cuisines to choose from. [reflection] First tell me about the foods you already make. [open-ended question]
client: I make good spaghetti. I’ve made that for my boyfriend and
he loves it. I also make a pesto ravioli dish where you just buy the
prepared ravioli and the container of pesto and put it together. I’ll
sometimes add whatever vegetables I have on hand to that. Let’s
see . . . if I’m feeling lazy, I’ll make a quesadilla in the microwave.
I’ve found those precooked chicken breasts at the store and will
sometimes add those to whatever I’m cooking. That’s about it.
Maybe a few others, but not very many.
pRactitioneR: OK, those are some good ones. You already have some
great ideas about putting convenient, time-saving foods together
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to make an overall healthy and tasty meal. [affirmation] If it’s OK
with you let’s also talk about how you can branch out and try
some new and exciting dishes. [asking permission] How do you
prefer to find recipes? [open-ended question] Do you like using the
Internet? Cookbooks? Or do you like to watch cooking shows?
[closed-ended probing questions]
client: Oh yes, all of those methods work.
pRactitioneR: The Internet is a great resource for free recipes. And
sometimes just browsing the recipes in the “Quick and Easy” rec-
ipe collection can get those creative juices flowing. [giving infor-
mation] I can give you some of my clients’ favorite recipe websites,
if you’d like? I also have some quick, easy recipe ideas here on this
handout [Handout 13.1]. Would you be interested in taking a look
at this together? [giving a menu of options and asking perm
ission]
client: Yes, that would be great.
pRactitioneR: As you glance at this handout, which, if any of these
sounds like something you’d like to try? [open-ended question]
exPAndIng Food vArIety
Variety is not only the spice of life, but instrumental in ensuring a diet full of essential vitamins and minerals. Children and adults often have very limited food acceptance. The term food acceptance is defined by Ellyn Satter (2008) as being comfortable with the foods you like, flexible about the foods you choose, and interested in new foods, discovering ways to learn to like them. Picky-eating children often grow up into finicky adults with nutritional deficits that can contribute to chronic disease. Many adults have limited food acceptance, and we do our best to cater to their needs when we invite them to dinner. However, what if the picky eater is your client?
If your client has a limited food selection and is interested in trying new foods and expanding his variety, invite him to brainstorm a list of foods preferred, foods detested, and foods in between (neither liked nor hated). Ask open-ended questions to determine the origin of the food dislikes. It can be useful to assess whether the repulsion is due to flavor, texture, appearance, or a traumatic childhood event. If he’s interested, explain that it often requires several exposures to a new food before it is accepted.
Invite him to select a food from either the foods detested or the foods in between list and begin discussing how he would go about preparing this
food, if he were to try it again.
With permission, invite him to consider trying that novel food with a
food that he likes. For example, if he dislikes cauliflower but likes cheese, perhaps he’d be more willing to try the cauliflower if it’s smothered in
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cheese. Toppings such as cheeses, sauces, salad dressings, and butter can dramatically improve the taste of a disliked food. Many refrain from using these items out of concern for nutrition. However, these items may be
necessary at first to increase palatability. Over time, the client will likely find that large amounts of the topping may not be necessary for long-term enjoyment. And for clients who require a dietary restriction to manage a disease or condition, nutritionally altered products can be used. For example, if ranch dressing is helpful for increasing acceptance of bell peppers, and the client is concerned about dietary fat, then a low-fat ranch dressing can be used.
Many fail to meet the recommended dietary guidelines for fruits and
vegetables. Therefore, assisting a client in expanding his food variety often means exposing him to new fruits and vegetables. Clients who eat inadequate amounts of these foods often voice a number of barriers including taste, the perishable nature of fresh produce, cost, and a general lack of skills to prepare them in a pleasurable way. Clients can use a number of strategies to add fruits and vegetables to meals and snacks (Handout 13.1).
When providing these ideas, it’s important to do so in an E-P-E format.
Ideas can be provided in a menu option as in the following script:
pRactitioneR: You seem motivated to start adding more fruits and
vegetables into your diet. What ideas do you have for how you
might go about doing this? [elicit]
client: I noticed those mandarin oranges are in season right now. I
like those because they aren’t too messy and easy to take with me.
For vegetables, I’m really running out of ideas. I tend to stick to
only three different vegetables—corn, carrots, and potatoes.
pRactitioneR: You’re interested in trying some seasonal fruit and feel
a bit stuck with your vegetable selection. [reflection] Would you
be interested in hearing other ideas? [asking permission] Some of
my clients like drinking fruit smoothies for breakfast or adding
a banana or berries to cereal in the morning. Others prefer cut-
ting up vegetables ahead of time and enjoying them with lunch or
snacks dipped in salad dressing or hummus. Another idea is to
add more entrees to your dinner items that have vegetables built in
like soups, casseroles, or stir fries. Or perhaps you’d prefer micro-
waving or steaming fresh, canned, or frozen vegetable side dishes
or adding salads. [provide] Which, if any of these ideas would you
like to explore further? [elicit]
This is one way to offer suggestions to your client. In the following
script, the client reports she has limited acceptance of fruits and vegetables and expresses a desire to expand and try new foods. The practitioner guides
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her through the planning process by listening for and evoking change talk and reflecting it back, ultimately moving the client through ambivalence and toward change.
pRactitioneR: From this list of strategies to reduce constipation,
you’ve selected adding fiber by eating more fruits and vegetables.
[reflection] What led you to choose that particular topic? [evoking
change talk with an open-ended question]
client: I know I don’t eat enough of them. [change talk—need to
change] There aren’t very many that I really like. [sustain talk]
And I’m sure that eating more would help move things along.
[ambivalence]
pRactitioneR: Despite the fact that you don’t care much for fruits
and vegetables, you want to challenge yourself in this area and
recognize the importance of adding more fruits and vegetables in
alleviating your constipation. [reflection of change talk]
client: Yes. I have a feeling if I just learned how to make fruits and
vegetables taste good, I’d probably be able to add more to my diet.
[change talk—ability to change]
pRactitioneR: Preparing fruits and vegetables in a tasty manner
sounds like your biggest challenge. [reflection of change talk]
client: Right.
pRactitioneR: Can I give you some information about trying new
foods that has encouraged other clients?
client: Yes.
pRactitioneR: Many of my clients find—and research supports
this—that repeatedly trying new foods in different ways increases
food acceptance. [giving information] Can you think of a food
you used to really despise that now doesn’t taste so bad? [closed-
ended question]
client: Oh, that’s an easy one—broccoli. I used to hate it. Now it’s
one of the only vegetables I eat.
pRactitioneR: Great example. [affirmation] Why do you think your opinion of broccoli changed? [open-ended question]
client: I don’t know. Probably because it came with a few of the
dishes I ordered at restaurants and I just kept trying it. This one
restaurant I always go to puts butter and lemon juice on it, and
it’s delicious.
pRactitioneR: That’s a good example of how preparation really can
make a difference. And you didn’t give up and kept tasting what
was on your plate. [affirmation]
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client: Yes, but now I only eat broccoli, carrots, corn, and peas.
pRactitioneR: OK, so those are the vegetables you prefer. [reflection]
What fruits do you like? [open-ended question]
client: Fruit is easier. I like oranges, grapes, apples, and pineapple.
I hate cantaloupe, watermelon, bananas, kiwi, and some berries
that are really sour.
pRactitioneR: Yes, sour fruit or any that isn’t quite ripe yet can really ruin the experience of that food. [reflection] Which fruits o
r vegetables that you don’t much care for are you interested in trying
again, if any? [open-ended question]
client: Someone told me about freezing bananas and dipping them in
chocolate. I do like chocolate. I could try that.
pRactitioneR: Great idea. [affirmation] What else?
client: Oh, tomatoes. I feel like I should give those another try. I’m
starting to like salsa, and tomatoes aren’t that different from salsa.
pRactitioneR: Another good idea. [affirmation] What ideas do you have for preparing tomatoes in a way that may be enjoyable?
[open-ended question]
client: I don’t know. I mean, I will occasionally try one drowned in
salad dressing if it’s served at a restaurant.
pRactitioneR: The salad dressing makes it more palatable. [reflec-
tion]
client: Well, sort of. The mushy center still catches me off guard as it mushes in my mouth.
pRactitioneR: So it’s a texture thing. [reflection]
client: Yes, but I don’t know why salsa doesn’t bother me; maybe
because it’s chopped up.
pRactitioneR: So perhaps chopping up tomatoes and adding them to
your meals might work. What other ideas do you have for adding
tomatoes in a way that you won’t notice or be turned off by the
texture? [open-ended question]
client: I don’t know.
pRactitioneR: Would you be interested in hearing some ideas? [ask-
ing permission]
client: Yes.
pRactitioneR: How would you feel about trying to add tomatoes
to hot dishes like pastas or soups? [open-ended question, giving
information]
client: Oh yeah, good idea. That could work.
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pRactitioneR: You found two places to start in terms of expanding
your fruit and vegetables selection: chocolate-covered bananas
and adding tomatoes to soups and pasta. [summary] What addi-
tional resources could I provide you to help you with this little
eating experiment? [open-ended question]
In this dialogue, the practitioner invites the client to navigate a delicate balance between the discomfort of trying new foods to help manage
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