by Beverly Ekaitis, DTR, dietetic technician at The Children's Institute of Pittsburgh (TRI)
Editors’ Note: The USDA’s Food Guide Pyramid provides an appealing
graphic tool far thinking about a day’s food portions, but it simply adds up
to too much food for someone on a Prader-Willi diet. We asked the Children's Institute if they could adapt the new pyramid to the typical PW diet for
families that might wish to use it as an alternative to the Exchange System,
the Red-Yellow-Green (Stoplight) Diet, or other methods of counting calories.
The Institue was glad to oblige but urges those who have been through the
Institue’s
program to continue using the Red-Yellow-Green Diet that they learned there.
The Prader-Willi Food Pyramid that follows may not be appropriate for young
children or for those on growth hormone therapy, and it should not be
considered a substitute for individualized dietary guidance. Dietary
guidance preferably should come from a nutritionist who is familiar with
PWS.
The Food Pyramid Guide to Daily Food Choices, designed by the U.S. Department
of Agriculture for adults who need 1,600 to 2,800 calories a day, represents the
relative portions of foods to eat each day to maintain a healthy weight and
body. To make the Food Pyramid usable for people with Prader-Willi syndrome, a
few changes have to be made.
The first change needed is to adjust the number of daily servings for each
food group in order to reduce the total calorie level to 800 to 1,200 a day.
These lower levels will provide for weight loss or maintenance for the adult or
teenager with PWS, whose calorie needs are about 60 percent of those without
PWS.
Second, although the five main food groups—bread, vegetable, fruit, meat,
and milk—remain the same, the positions of two of the groups need to be
changed on the pyramid to reflect a change in the recommended number of
servings. Each group has a specific number of servings that determines its
position on the pyramid.
The Food Groups
The USDA Food Pyramid has a base of the Bread group, which would provide the
highest number of daily servings. The PW Pyramid, on the other hand, has as its
base the Vegetable group, with 6-8 servings a day. For those familiar
with the Red-Yellow-Green Diet, these would be "GO" foods, i.e., foods
low in calories and fat. Making the vegetable group the base of the pyramid and
the bulk of the diet will allow a large volume of food to be eaten without many
additional calories.
The Bread group, which includes cereal, pasta, and rice, moves up the
pyramid with a decrease in number of servings to three to five per day. We would
also include starchy vegetables like corn, peas, and potatoes in this group
because they have the same amount of calories per serving as breads.
The Fruit group includes fresh fruit, canned fruit, juice, and dried
fruits. Many people think of fruit as a "free" food. While it is a
good snack and a good source of fiber and vitamins, it does have calories that
should be counted if one is on a restricted diet. The daily servings should be
four—one at each meal and one for snack.
The Milk group includes yogurt, milk, and cheese. To fit the needs of
the person with PWS, the servings per day should be two, and the products chosen
should be nonfat or low in fat. Fat-free, sugar-free frozen yogurt also can be
used as a milk serving.
The Meat group includes meat, fish, poultry, eggs, peanut butter, and
cooked dried beans. The USDA also includes nuts in this group, but due to their
high fat content they should be eliminated from the PW Pyramid. And the USDA
suggests two to three meat servings per day of 2½-to-3-oz. portions. To
decrease the calories for the PW meal plan, we changed the portion size to 2 oz.
and suggest one to two servings a day. This means that a person on 800 calories
could divide the 2 oz. serving to provide 1 oz. at lunch and 1 oz. at dinner,
and a person on 1,200 calories could have 2 oz. at lunch and 2 oz. at dinner.
Serving Sizes
Except for the meat group, the serving sizes on our PW Pyramid are unchanged
from the USDA Food Pyramid. They are as follows:
- Vegetable: 1/2 cup cooked or 1 cup raw
- Bread: 1 slice bread; 1/2 cup rice, pasta, or starchy
vegetable; 1 oz. cereal
- Fruit: 1/2 cup canned, 1/2 cup or 1 piece fresh, 1/4 cup
dried; 1/2 cup juice
- Milk: 1 cup skim milk or lite yogurt, 1 oz. cheese, 1/2
cup frozen fat-free sugar-free yogurt
- Meat: 2 oz. cooked lean meat, fish, ~poultry; 1 egg, 1/2
coup cooked dried beans; tablespoons peanut butter
Fats, Oils, and Sweets
The top of the USDA Pyramid shows fats, oils, and sweets.
These are denoted by symbols that are concentrated in this area and
dispersed throughout the other groups. The USDA suggests that
these foods be used sparingly to add extra calories. These foods
include butter, margarine, regular dressing, candy, sugars, sweets,
fatty desserts, gravy, and fried foods, to name a few. The foods
from this group add unwanted calories and few nutrients to the
Prader-Willi diet. They should be limited to once a month for an
800-calorie plan and once a week for a 1,200-calorie plan. We have
deleted the fat symbols throughout the PW Pyramid, because all foods
chosen should be low in fat and sugar.
Using the modified pyramid as a guide to weight loss and maintenance,
in conjunction with a favorite exercise program, can be an easy way to
ensure a healthy, nutritious diet for the person with Prader-Willi
syndrome.
