August 2011 Issue
By Lindsey Getz
Vol. 13 No. 8 P. 8
They can be helpful management tools but are not for everyone.
Some dietitians say maintaining a healthful diet to manage diabetes is easier to do with a food scale. But while food scales can certainly be handy tools, they aren’t for everyone. In fact, for some, they can make the task of managing diabetes seem even more overwhelming. The trick is to know when to recommend food scales and when to suggest other methods.
“Food scales are beneficial because they create awareness,” says diabetes educator Lorena Drago, MS, RD, CDN, CDE, a spokesperson for the American Association of Diabetes Educators (AADE). “Food scales are the GPS of nutritional roadways. When a person is diagnosed with diabetes, their meal plans come under scrutiny. I tell my patients to focus on their P’s and Q’s, where P stands for portion and Q for quality. Since food portions have changed over the years, including the size of plates and cups, food scales reacquaint patients with portions.”
A variety of food scales are available, and each one works a little differently. Some of the more elaborate ones will automatically inform the user how much carbohydrate a food has—obviously important when it comes to understanding how food can impact blood sugar control. Others will simply measure the amount of food, and the user will need to do the math to figure out certain nutrients.
Of course, the more elaborate the scale, the more a patient can expect to pay for it. Dawn Sherr, RD, CDE, LDN, a diabetes educator and practice manager with the AADE, says she doesn’t like to recommend specific brands. RDs may offer some guidance in answering questions, but she believes patients need to determine what works best for them.
“It really depends on what they want,” she says. “It needs to be a scale that fits into their budget and also meets their needs. I wouldn’t say there’s any one particular scale that’s best because it really comes down to each individual patient and what they need.”
Tami Ross, RD, LD, CDE, a personal diabetes and nutrition educator, writer, and speaker as well as vice president of the AADE, says starting with an inexpensive scale, available for purchase at most grocery stores, is wise. But she’s had a couple of patients tell her they’ve used a postal scale. If patients embrace the idea of measuring food, they can always opt to purchase a more elaborate food scale later.
“An inexpensive scale will at least get the patient in the ballpark of portion sizes without investing a lot of up-front money,” says Ross. “A lot of patients have no idea what portion sizes look like, so it’s often a reality check to find out how much they’re really eating.”
Not for Everyone
Some RDs say they prefer not to recommend that patients use food scales. Janice H. Dada, MPH, RD, CSSD, CDE, CHES, of SoCal Nutrition & Wellness, says she believes patients don’t need them. Instead, she teaches her clients to use their hands for approximate measurements or encourages them to use measuring cups. She says it’s more practical and helps patients stick to their plan even when they’re eating out.
“People can go anywhere and estimate portions if they know how to estimate [on their own],” says Dada. “Diabetes is a complex disease, and people with the disease often experience burnout. Thus, the simpler we can make our recommendations, the better. Once a person with diabetes realizes that management doesn’t have to be so complicated, they will feel more empowered and motivated to take control of the disease.”
Dada teaches clients that 1 cup is approximately the size of a woman’s fist; 1/2 cup is the palm of her hand; 3 to 4 oz of meat or fish is a deck of cards or the palm of a woman’s hand; and 1 T is the measurement of a thumb from tip to base.
“I teach clients these tips and even have a visual guide to estimating portions on my website that they can download and refer to as needed,” she adds.
Even those RDs who do consider food scales a useful tool recognize they aren’t for everyone. Drago says some patients believe weighing and measuring food takes away from the joy of eating since it removes spontaneity and disrupts family meals. Other patients simply dislike rules, and food scales may make managing diabetes seem even more constricting.
Drago says the only way to know whether patients will do well with a food scale is to talk to them about it. She offers this example dialogue as a way to introduce patients to the idea of food scales and help determine whether using one is right for them: “In order to know if your carbohydrate budget is appropriate for you, you may need to keep track of your food portions. Some people find scales very useful. It gives them an accurate picture of the total carbohydrates eaten in one meal. Some others do not find them useful. In that case, I can tell you how to estimate your portions. Which option is best for you?”
Another factor to consider in suggesting food scales is where patients are in terms of disease management. If they were recently diagnosed, using a food scale may seem too overwhelming, says Sherr. Every patient is different and may handle the diagnosis and management differently.
“Food scales might be better for someone who has been living with diabetes for a while and is looking to really fine-tune their control,” Sherr adds.
It’s also important to recognize that using a food scale doesn’t need to be an everyday chore. In fact, Ross says she’s never run across a patient who uses a food scale every day. “Particularly motivated individuals may use one pretty diligently for a few weeks or even a month,” she says. “Then they typically have a pretty good grasp of measuring portion sizes on their own.”
Once patients get a good grasp on portion size, they may use the scale occasionally to gauge how they’re doing. “Maybe once a month patients will measure food and see if they’re on target with portion sizes,” says Sherr. “I’ve suggested that patients pour their cereal into a bowl as though they were going to eat it and then measure what they poured out. It’s just a good way to see if they’re staying on track.”
While food scales can be helpful, they may also add stress to a patient’s life. In that case, dietitians should help patients find another means of measuring portion sizes. “The goal is to have a patient become more aware of the amount and quality of food that they eat,” says Drago. “How they get there is up to them.”
— Lindsey Getz is a freelance writer based in Royersford, Pa.