Nutrition Education Institute Nutrition Content

Transcription

1 Nutrition Education Institute Nutrition Content Alison Rainey Doak, MS, RD, LDN Dietitian and Nutrition Educator John C. Stalker Institute of Food and Nutrition 2012

2 Nutrition Content Introduction and Goals Participants will acquire the functional knowledge necessary to understand what healthy eating and good nutrition mean Participants will become more comfortable utilizing this knowledge to develop skills-based nutrition lessons and unit

3 Key Concepts Goals of Nutrition Education MyPlate Energy Balance Special Dietary Considerations Label Reading Body Talk Media Influence and Body Image Reviewing Web Resources

4 Pop Quiz! Which of the following breakfast items that are served at Denny s restaurants do you think has the fewest calories? A. Ham and cheddar omelet B. Country fried steak and eggs C. Three slices of French toast w/syrup and margarine D. Three pancakes w/syrup and margarine From: Fast Food IQ Test (California Center for Public Health)

5 Pop Quiz! Which of the following items that are served at Chili s restaurant, do you think has the least salt? A. Cajun chicken sandwich B. Classic combo chicken & steak fajitas C. Guiltless chicken platter D. Smoked turkey sandwich From: Fast Food IQ Test (California Center for Public Health)

6 Pop Quiz! Which of the following items that are served at McDonald s restaurants do you think has the most calories? A. Two Big Macs B. Two Egg McMuffins C. One Large Chocolate Shake D. Four Regular Hamburgers From: Fast Food IQ Test (California Center for Public Health)

7 Pop Quiz! Which of the following items that are served at Romano s Macaroni Grill restaurant, do you think has the most fat? A. Traditional Lasagna B. Chicken Caesar Salad C. Pasta Classico D. BBQ Chicken Pizza From: Fast Food IQ Test (California Center for Public Health)

8 The Score Goal is not memorization of arbitrary nutrition information or facts These details are useless if students don t know how to FIND the information or what to DO with this information Information alone will not contribute to meaningful behavior changes

9 So, what are we trying to do? Provide tools to enable students to make healthy choices for themselves Provide healthy role models Support healthy decisions with policy and a healthy school environment Empower students to resist unrealistic and unhealthy cultural pressures re: Body image, nutrition, fitness, weight Foster healthy body image To motivate students to take ownership and have a stake in wholesome eating and physical fitness Support behavior change

10 Nutrition: an Evolving Science

11 WHAT IS NORMAL EATING? WHAT IS NORMAL EATING?

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13 But how big IS that plate?!

14 MyPlate Basics MyPlate is part of a larger communications initiative based on 2010 Dietary Guidelines for Americans to help consumers make better food choices. MyPlate is designed to remind Americans to eat healthfully; it is not intended to change consumer behavior alone. MyPlate illustrates the five food groups using a familiar mealtime visual, a place setting.

15 MyPlate Pointers Balance Calories: enjoy your food, but eat less. Avoid oversized portions. Foods to Increase Make half your plate fruits and vegetables. Make at least half your grains whole grains. Switch to fat-free or low-fat (1%) milk. Foods to Reduce Compare sodium in foods like soup, bread, and frozen meals and choose foods with lower numbers. Drink water instead of sugary drinks.

16 Fruit What Counts? Any fruit or 100% fruit juice counts as part of the Fruit Group. Fruits may be fresh, canned, frozen, or dried, and may be whole, cut-up, or pureed. ¼ cup raisins = ½ cup fruit ½ cup juice = ½ cup fruit 1 small orange = ½ cup fruit

17 How Much?

18 Fruit Vs. Juice Juice and juice drinks are a concentrated source of calories and sugar 100% juice may have vitamins and minerals, but excess amounts can lead to energy imbalance Limit to 4-6oz. (age 1-6)and 8-12 oz (age 7-18) daily Whole fruit is a better choice More fiber more satisfying Fewer calories

19 Vegetables Any vegetable or 100% vegetable juice counts as a member of the Vegetable Group. Vegetables may be raw or cooked; fresh, frozen, canned, or dried/dehydrated; and may be whole, cut-up, or mashed. ½ cup tomato juice = ½cup vegetables ½ cup cooked broccoli = ½ cup vegetables ½ cup beans = ½ cup vegetables 1 cup raw baby spinach = ½ cup vegetables

20 How Many vegetables? Subgroups: Dark Green Red and Orange Beans and peas Starchy Vegetables Other Vegetables

21 Grains Any food made from wheat, rice, oats, cornmeal, barley or another cereal grain Bread, pasta, oatmeal, breakfast cereals, tortillas, and grits are examples of grain products. Grains are divided into 2 subgroups: Whole Grains Refined Grains Whole grains contain the entire grain kernel the bran, germ, and endosperm.

22 Anatomy of a Grain Whole Grain Bran, germ, endosperm. Refined Grain Minus the bran and germ. Loss of fiber, vitamins, minerals, lignans, phytoestrogens, phenolic compounds and phytic acid Enriched Addition of nutrients that were lost during processing. Fortified Addition of nutrients to a food which were not present in the original food.

23 How Much?

24 What Counts A one ounce equivalent = 1 slice of bread 3 cups popcorn 1 mini bagel ½ cup cooked pasta 5 whole wheat crackers (i.e. triscuits) Cereal: 1 cup flakes 1 ¼ cup puffed cereal ½ English muffin

25 Label reading Choose foods with a whole grain ingredient listed first on the label s ingredient list. Ingredients are listed in descending order of weight, from most to least.

26 Which is the whole grain bread? Wheat flour, water, high fructose corn syrup, molasses, wheat bran Whole wheat flour, water, brown sugar

27 Answer: has WHOLE wheat as the first ingredient! Wheat flour, water, high fructose corn syrup, molasses, wheat bran Whole wheat flour, water, brown sugar

28 Nutrition Facts Label Use Nutrition Facts label to help choose whole grain products with a higher % Daily Value (%DV) for fiber. The %DV for fiber is a good clue to the amount of whole grain in the product.

29 Watch wording on grains! Foods are usually not whole grain products if labeled with these words: Multi-grain Stone-ground 100% wheat Cracked wheat Seven-grain Look for the following: Whole wheat flour, Whole oats While bran provides fiber, which is important for health, products with added bran or functional fibers are not necessarily whole grain products. Many Light or Diet breads have a lot of added fiber.

30 Fill up on Fiber Aim for grams/day Keeps you full longer Helps manage weight Keeps your blood sugar stable Helps manage diabetes Aids in digestive health Helps lower cholesterol, reducing the risk of heart disease Include more Whole grains and get adventurous. Be a savvy shopper read labels!

31 Protein All foods made from meat, poultry, seafood, beans and peas, eggs, processed soy products, nuts, and seeds are considered part of the Protein Foods Group. Beans and peas are also part of the Vegetable Group* ½ cup cooked kidney beans = 2 ounce equivalents protein foods 3 ounces cooked Chicken = 3 ounce equivalents protein foods 2 ounces cooked shrimp = 2 ounce equivalents protein foods 1 ounce = (25) almonds 2 ounce equivalents protein foods and 2 teaspoons oil

32 How Much?

33 Protein Power Protein helps you feel satisfied longer Eating dietary protein does NOT build muscle Adequate protein is necessary for muscle growth, but excessive amounts of protein are not necessary Include protein as part of balanced meals and snacks Breakfast: Nuts and nut butters like almond or peanut butter, seeds, tofu, egg, ham, yogurt, milk, soymilk, cheese Lunch and dinner protein foods include: beans, lentils, chickpeas, tofu, eggs, nuts, seeds, meat, fish, poultry, milk, yogurt, soymilk, cheese.

34 Protein Perspective How much protein do we need? Rule of thumb for protein needs: Most people need about 0.8 g of protein per kg of body weight Children: 4-8 y 19g 9-13y 34g 14-18y 52g

35 Protein Perspective How much protein do we actually need? Rule of thumb for protein needs: We need 0.8 g of protein per kg of body weight Athletes- Up to 1.2 to 1.5g/kg Start of weight lifting regime, long-distance runners, marathoners g/kg Upper limit 2.0 g/kg For instance, a 130 pound (59 kg) woman would need 47 grams of protein daily. 59kg x.8g/kg = 47 g protein To figure out your weight in kilograms, divide your weight in pounds by 2.2

36 Protein Perspective 16.5 g Peanut Butter 5 grams (1 Tbsp.) Yogurt 7 grams Toast 3 grams Banana 1.5 grams

37 Protein Perspective 20 g Red Beans 8 grams (½ cup) Skim Milk 9 grams ( 1 cup ) Whole Wheat Dinner Roll 3 grams

38 Protein Perspective 10.5 g Pasta 7.5 grams ( 1 cup ) Side Salad 1 gram ( 1 cup ) Parmesan Cheese 2 grams ( 1 Tbsp )

39 Protein Perspective Protein Totals Breakfast Lunch Dinner 16.5 g g 10.5 g 47.0 g Recommendation: 47 g

40 Protein Perspective 24 g Bacon 9 grams (3 slices) Toast 3 grams 2 Eggs 12 grams

41 Protein Perspective 37.5 g Sandwich 26.5 grams (½ cup) Cheese: 6g Bread (2): 6g Turkey (3 oz.): 14.5 g Skim Milk 9 grams ( 8 oz. ) Potato Chips 2 grams ( 1 oz. )

42 Protein Perspective 30 g Pasta 7.5 grams ( 1 cup ) Meatballs 19.5 grams Side Salad 1 gram ( 1 cup ) Parmesan Cheese 2 grams ( 1 Tbsp )

43 Protein Perspective Protein Totals Breakfast Lunch Dinner 24.0 g g 30.0 g 91.5 g Recommendation: 47 g

44 Foods have more protein than you think Serving Protein grams Meat, Fish, Poultry: 1 oz. 7 Hamburger 4 oz. 28 Chicken leg 2.4 oz ½ C 19 Cheese 1 oz 7 Garden Burger 2.3 oz 11 Kidney Beans 1 cup 13 Vegetables: 2 Carrots ½ cup 2 Starch: 3 Bread 1 slice 3 Milk 8 oz 8 Eggs 1 6

45 Vegetarian Diets Tend to be lower in fat and total calories than non-vegetarian diets Higher in fiber, potassium, and vitamin C than non-vegetarian diets Vegetarian diets are nutritionally adequate if well planned; in fact, it s a misconception that vegetarians can t get enough protein easily

46 Categories Lacto-ovo: do not eat beef, pork, poultry, fish, shellfish or animal flesh of any kind, but they do eat eggs and dairy products Pescatarian: do not eat animal flesh with the exception of fish and seafood Flexitarian ( semi-vegetarian ): eat mostly vegetarian foods, but occasionally eat meat Vegan: do not eat eggs, dairy products, meat of any kind or processed foods containing these or other animal-derived ingredients such as gelatin (leather, cosmetics, honey, etc.)

47 Considerations People adopt these lifestyles for a variety of reasons (religious, cultural, ethical, health, etc.) Key to adequate nutrition is eating a wide variety of foods and finding alternative sources of nutrients such as: Vitamin D, calcium, iron, Omega-3s, Vitamin B12 Without appropriate meal planning and/or supplements, adolescents may be at risk for nutrient deficiencies

48 Dairy Fluid milk and many foods made from milk are considered part of this food group. Foods made from milk that have little to no calcium, such as cream cheese, cream, and butter, are not. Calcium-fortified soymilk is part of the dairy group 1/3 cup shredded cheese= 1cup dairy 1 cup milk = 1cup dairy 1 cup yogurt = 1cup dairy Most Dairy Group choices should be fat-free or low-fat.

49 How Much? 1,000 1,300 mg

50 Dairy Alternatives Many adolescents do not get enough calcium Don t like milk, don t drink milk, etc. Important to find other sources of calcium Food Non-Dairy Milks: Rice, Almond, Soy, Hemp Dark green vegetables Fortified foods and juices: cereals, waffles, orange juice Supplements Chewables Capsules

51 Oils Oils are fats that are liquid at room temperature: Canola oil corn oil cottonseed oil olive oil safflower oil soybean oil sunflower oil Some foods are naturally high in oils nuts olives some fish avocados

52 Solid Fats Solid at room temperature, like butter and shortening. Solid fats come from many animal foods and can be made from vegetable oils through a process called hydrogenation (trans fats). Some common fats are: butter milk fat beef fat (tallow, suet) chicken fat pork fat (lard) stick margarine shortening partially hydrogenated oil

53 How much?

54 Another way to look at it.. The Nutrition Facts label lists reference values for daily fat intake Less than 20g 25g

55 What counts?

56 Empty Calories Calories from added fat and sugars Solid fats: fats that are solid at room temperature, like butter, beef fat, and shortening. Some occur naturally in foods and some are added when foods are processed/prepared Added sugars: sugars and syrups that are added when foods or beverages are processed/prepared Most empty calories in the American diet come from: Sugary beverages (soda, energy drinks, juice drinks) Cheese (Pizza) Pastries, cakes, donuts Fatty meats: sausage, bacon, ribs, hot dogs Some foods are all empty calories (candy, soda)

57 Sugar Many different names for sugar corn syrup, high-fructose corn syrup, dextrose, maltodextrins, granulated sugar, or concentrated fruit juice sweetener, evaporated cane juice All sugar contributes the same number of calories Major source of added sugar is sweetened beverages

58 Sports Drinks Developed for athletes who work out vigorously, to: rehydrate (read: water) replenish fuel (read: calories) replenish electrolytes (read: potassium, sodium, chloride) Gatorade Orange Sports Drink Water, sucrose syrup, glucose-fructose syrup, citric acid, natural orange flavor with other natural flavors, salt, sodium citrate, monopotassium phosphate, yellow 6, ester gum, brominated vegetable oil Most students do not need sports drinks; they just need fluid 16 ounce Gatorade has 60 mg potassium; a carrot has 230 mg A 32 ounce bottle of Gatorade has 200 calories

59 Is vitamin water okay? Water has great market potential Need to read labels carefully Mass AHK guidelines water or flavored water "without added sugar, artificial sweeteners or caffeine" Vitamins and minerals and other ingredients are being added to increase market differentiation Marketing statements are OUTRAGEOUS Providing 50% of certain vitamins and minerals is like taking a supplement

60 Bottom Line Limit or avoid beverages that contain added sweeteners, artificial sweeteners, or caffeine Essentially = Water + sugar + vitamin/mineral supplement Not needed by anyone Risk over supplementation Marketing ploy Research on special ingredients is emerging Doubt the levels in these drinks are metabolically significant Expensive

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63 THINK YOUR DRINK ACTIVITY

64 Energy Balance IN Calories from Food & Beverages OUT Physical Activity* (for weight maintenance) If you want to lose weight, you need to decrease calories from food OR increase calorie expenditure, OR Both

65 Energy Balance For weight maintenance: Goal is: Calories IN = Calories OUT For weight loss: Calories OUT must > Calories In. Can be accomplished by: Cutting calories A combination of BOTH is the most effective strategy! Exercising more How many calories should you have? Depends on many factors: age, weight, gender, activity level, etc. Females usually require fewer calories than males because they tend to be smaller, and have less lean muscle mass and greater body fat % (following puberty) Check out for an estimate

66 Portions vs. Servings* A portion is the amount of food that you choose to eat for a meal or snack. It can be big or small you decide. 3 scoops of ice cream A serving is a measured amount of food or drink, such as one slice of bread or one cup (eight ounces) of milk. Servings are comparable for similar types of foods (i.e. cereals, bread, crackers)

67 The Bagel 20 Years Ago Today 140 calories 3-inch diameter 350 calories 6-inch diameter Calorie Difference: 210 calories

68 Muffins 20 Years Ago Today 210 calories 1.5 ounces 500 calories 4 ounces Calorie Difference: 290 calories

69 Pound Perspective Even small changes add up (or down!) Consider this Sally drinks 1 Coke every afternoon (140 calories) She would really like to lose weight She does the math and realizes that: 1 coke/day x 365 days/year = 51, 000 calories. So what? So, that s the caloric equivalent of 15 pounds!!

70 Satisfaction Response: Carbohydrates Goal: 45-65% of total calories Simple Sugars min Complex Carbohydrates Hunger Suppression Food Intake ~30-45 minutes Time

71 Satisfaction Response: Protein Protein 1-2 hours Hunger Suppression Food Intake Time

72 Satisfaction Response: Fats Fat 2-3 hours Hunger Suppression Food Intake Time

73 Total Satisfaction Response Sugar Starch Protein Fat Hunger Suppression Food Intake Time

74 Why do we eat? What influences us?

75 Hunger and Satiety Recognize hunger and satiety Work toward eating only when hungry and stopping when satisfied, not stuffed Variety of influences cause us to eat when we aren t actually hungry

76 Eat Breakfast and Don t Skip Meals Research shows that: People who eat breakfast have lower body weights than those who skip it They are also less likely to snack mindlessly throughout the day. Breakfast eaters have less abdominal fat than those who skip Children who eat breakfast are more attentive in school Eat meals and snacks regularly throughout the day (every 3-4 hours) To avoid feeling deprived To maintain stable blood sugar and energy To maintain metabolism To prevent over eating later

77 Get Rested Sleep affects the hormones that influence our appetite and fat storage mechanisms cortisol, leptin and insulin A lack of sleep makes metabolic processes less efficient (read: lowers metabolism) The more rested we are, the more energy we have to continue to be active Research has shown that inadequate sleep correlates with increased BMI

78 WIIFM? Gear nutrition messages to the students Find out what they NEED to know Find out what they WANT to know Understand what motivates them Appearance/looking good Doing well in school Athletic performance Find out what they perceive the advantages are Meet them where they are

79 CREATING EDUCATED CONSUMERS

80 Creating Educated Consumers Choosing products wisely Labels Recognizing influences on body image Critical consumption of Media Separating fact from fiction Claims, promises, etc. Analyzing media Advertising Web-based health information

81 If it sounds to good to be true it probably is! This can prove true for product claims, health claims, weight loss promises, supplement claims What does the product claim? Do results seem rapid or unrealistic? How much does it cost compared to similar products? Do you understand how the product works and how it affects your body?

82 Label Lingo

83 What is a Daily Value? Reference values used to assist consumers in understanding how nutrients fit into the context of the total daily diet in comparing nutritional values of food products Nutrient content claims 10% of the DV -Good source 20% or more of the DV- Excellent or High Dietary trade-offs DVs are not individual goals for intakes

84 Get Enough of These Nutrients Choose foods with the higher % DV for these nutrients

85 Calcium Considerations Calcium Calcium has %, but not weighted amounts(mg) % based on 1,000 mg Teens need 1,300 mg

86 Limit These Nutrients The goal is to stay BELOW 100% of the DV for each of these nutrients each day. Select foods that are lowest in saturated fat, trans fat, and cholesterol to help reduce the risk of heart diseaset sodium to reduce your risk of high blood pressure

87 The Footnote Less than 20g 25g

88 How Daily Values relate to %DV Nutrient Total Fat Saturated fatty acids Cholesterol Sodium Potassium Total carbohydrate Fiber Protein Vitamin A Vitamin C Calcium Iron Vitamin D Vitamin E Daily Values 65 g 20 g 300 mg 2400 mg 3500 mg 300 g 25 g 50 g 5000 IU 60 mg 1000 mg 18 mg 400 IU 30 IU Folate 400 µg

89 What s High? What s Low? Do You Have to Calculate to Know? Footnote

90 The % DV Does the Math for You Look here for highs and lows!

91 General Guide to Highs and Lows Calories* 40 Calories is low 100 Calories is moderate 400 Calories is high Daily Values 5% DV or less is low i.e. low in sodium 20% or more is high No DVs for: i.e. high in fiber trans fats, *Based sugar, on protein a 2,000-calorie diet. * Based on a 2,000 calorie reference diet

92 Ingredient Info Plain Yogurt INGREDIENTS: CULTURED PASTEURIZED GRADE A NONFAT MILK, WHEY PROTEIN CONCENTRATE, PECTIN, CARRAGEENAN. Fruit Yogurt INGREDIENTS: CULTURED GRADE A REDUCED FAT MILK, APPLES, HIGH FRUCTOSE CORN SYRUP, CINNAMON, NUTMEG, NATURAL FLAVORS, AND PECTIN. CONTAINS ACTIVE YOGURT AND L. ACIDOPHILUS CULTURES

93 Food-A-Pedia

94 Super Tracker Tools

95 Who Am I? Strawberry Banana Bash, Cultured Pasteurized Grade A Reduced Fat Milk, Sugar, High Fructose Corn Syrup, Modified Cornstarch, Whey Protein Concentrate, Nonfat Milk, Kosher Gelatin, Citric Acid, Natural Flavor, and Artificial Flavor, Potassium Sorbate, Added to Maintain Freshness Red 40, Yellow 5, Retinyl Acetate (Vitamin A), Vitamin D3. Raspberry Rainbow, Cultured Pasteurized Grade A Reduced Fat Milk, Sugar, High Fructose Corn Syrup, Modified Cornstarch, Whey Protein Concentrate, Nonfat Milk, Kosher Gelatin, Citric Acid, Potassium Sorbate, Added to Maintain Freshness Natural Flavor, and Artificial Flavor, Red 40, Blue 1, Retinyl Acetate (Vitamin A), Vitamin D3. Tattoo Sugar, Modified Cellulose, Water, Modified Cornstarch, Glycerin, Dextrose, Polyglycerol Esters of Fatty Acids, Cornstarch, Natural Flavor, and Artificial Flavor, Citric Acid, Potassium Sorbate, (Preservative) Sucralose, Blue 1, Yellow 5, Red 3. Source:

96 Who Am I? Unbleached Enriched Wheat Flour (Flours, Niacin, Reduced Iron, Thiamin Mononitrate [Vitamin B1], Riboflavin [Vitamin B2], Folic Acid), Cheddar Cheese (Pasteurized Milk, Cheese Culture, Salt, Enzymes, Water, Salt), Vegetable Oils (Canola Oil, Sunflower, and/or Soybean), Contains 2 Percent or Less of Salt, Yeast, Sugar, Yeast Extract, Leavening Baking Soda, Monocalcium Phosphate, Ammonium Bicarbonate), Spices, Annatto (Color), and Onion Powder. Source:

97 Who Am I? Filling, (High Fructose Corn Syrup, Corn Syrup, Apple Puree Concentrate, Glycerin, Sugar, Modified Cornstarch, Sodium Alginate, Malic Acid, Sodium Citrate, Modified Cellulose, Dicalcium Phosphate, Cinnamon, Citric Acid, Caramel Color). Enriched Flour, (Wheat Flour, Niacinamide, Reduced Iron, Thiamin Mononitrate, (Vitamin B1), Riboflavin, (Vitamin B2), Folic Acid), Whole Grain Oats, Sugar, Sunflower Oil, High Fructose Corn Syrup, Contains Two Percent or Less of Honey, Calcium Carbonate, Dextrose, Nonfat Milk (Dry), Wheat Bran, Salt, Cellulose, Potassium Bicarbonate, Leavening Cinnamon, Natural Flavor, and Artificial Flavor, Mono And Diglycerides, Propylene Glycol Esters Of Fatty Acids, Soy Lecithin, Wheat Gluten, Cornstarch, Vitamin A Palmitate, Niacinamide, Carrageenan, Sodium, Iron, Pyridoxine Hydrochloride, (Vitamin B6), Thiamin Hydrochloride, (Vitamin B1), Riboflavin, (Vitamin B2), Folic Acid. Source:

98 Who Am I? Carbonated Water, Citric Acid, Taurine, Sodium Citrate, Maltodextrin, Natural Flavor and Artificial Flavors, Guarana Seed Extract, Ascorbic Acid, Caramel Color, Caffeine, Potassium Sorbate (to Protect Taste), Sodium Benzoate (to Protect Taste), Acesulfame Potassium, Sucralose, L-Carnitine, Inositol, Milk Thistle Extract, Ginkgo Biloba Leaf Extract, Niacinamide, Calcium Pantothenate, Eleutherococcus Senticosus, Riboflavin, Pyridoxine Hydrochloride, Cyanocobalamin. Source:

99 Food Labeling The messages we convey about food are important Consider the connotation Try to use positive language Instead of GOOD and BAD foods, try: sometimes and everyday foods Go, Slow, and Whoa foods Green Light, Yellow Light, Red Light All foods can fit This message sometimes gets lost

100 Practical Application Filtering out information Need to Know vs. Nice to Know Prioritizing What content could have the biggest impact? Opportunities to practice

101 Coming Back to Key Concepts Goals of Nutrition Education MyPlate Energy Balance Special Dietary Considerations Label Reading Body Talk Media Influence and Body Image Reviewing Web Resources

102 So, how can we.. Provide tools to enable students to make healthy choices for themselves? For their schools? Provide healthy role models? Support healthy decisions with policy and a healthy school environment? Empower students to resist unrealistic and unhealthy cultural pressures re: Body image, nutrition, fitness, weight Foster healthy body image To motivate students to take ownership and have a stake in wholesome eating and physical fitness? Support behavior change?

103 Wrap-up Q & A Introduce homework assignment Review/share websites