5 Food and nutrition
Briefing
This unit seeks to develop key language related to
nutrition and food before looking at skills to carry
out a nutritional assessment and offering advice on
improved diet. It also develops understanding of
conditions related to food intake – food allergies and
diabetes.
Nutrition
A healthy diet comprises roughly one-third fruit and
vegetables, one-third starchy foods and one-third
meat, dairy and oily, fatty and sugary foods. The
food pyramid (a graphic representation of the
different food groups and the proportions advised
for a healthy diet) is an authentic way of presenting
the key words for this first section of the unit.
Students are asked to draw on their general
knowledge of foodstuffs and nutrients –
carbohydrates, proteins, fats, vitamins, minerals,
fibre (and water) – and label the pyramid, indicating
dairy products, fresh fruit and vegetables, cereals,
etc. They will then go on to compile definitions of
the food groups, highlighting which of these fights
disease, repairs the body and helps digest food.
Describing quantities is necessary for a better
understanding of a patient’s diet and this unit
provides ample practice of countable and
uncountable nouns for this purpose.
Nutritional status
Good nutritional status is essential to the health and
well-being of the patient. Extra demands placed on
the body due to illness mean the need for nutrients
is increased. Poor nutrition can be associated with
delayed recovery; adequate nutrition not only
promotes tissue repair, but also aids recovery from
surgery and disease. Assessing nutritional status
involves taking measurements (see Unit 3) and
calculating the BMI or Body Mass Index. A patient
weighing 50 kg at 1.68 m would have a BMI of
50/1.68 x 1.68 = 17.7. A BMI of less than 18.5
indicates the patient is underweight while a BMI of
30+ is an indication of obesity.
Nurses also ask questions to determine the patient’s
food intake. In this section students will have the
chance to analyse a patient’s food journal to check if
he/she is eating a balanced diet.
Food allergies and intolerances
In the USA, food allergies affect nearly 4 percent of
the general population and it is estimated that such
allergic reactions cause 30,000 emergency room
visits and 150 to 200 deaths every year. 90 percent of
these are caused by milk, eggs, peanuts, tree nuts,
fish, shellfish, soy and wheat; and are often lifelong
conditions. There is no cure for a food allergy and
minute amounts of a food can cause a reaction in a
highly sensitive patient. Strict avoidance of the
allergy-causing food is the key to preventing allergic
reactions. A food allergy is an immune system
response to a food that the body mistakenly believes
is harmful. Once this happens, the patient
experiences an adverse reaction and the body
creates specific antibodies against the food. The next
time the individual eats that food, the immune
system releases massive amounts of chemicals,
including histamine, in order to protect the body.
These chemicals trigger allergic symptoms that can
affect the respiratory system, gastrointestinal tract,
skin or cardiovascular system.
Food intolerance does not involve the immune
system and is not life-threatening. Lactose
intolerance – trouble digesting the milk sugar lactose
– is a common example. Symptoms may include
abdominal cramps, bloating and diarrhoea.
The second part of this section provides discussion
on diabetes and takes students through the different
stages of administering a blood sugar test. Refer to
the text on page 41 for an explanation of Type 1 and
Type 2 diabetes.
Advice on diet
This section begins by reviewing key words used to
describe quantities and containers for food stuffs,
including carton, packet, segment. Students listen to
a school nurse giving government advice on
portions, focusing on the five-a-day campaign. The
section then moves to develop students’ skills in
giving suggestions and advice in a way that involves
the patient in the decision-making process and is
personalised/ adapted to the needs or lifestyle of the
patient. Use of tentative suggestions, How about +
-ing?, Can I suggest you + infinitive compared with
strong suggestions based on medical evidence: It is
advisable/important to + infinitive. Patient case
histories are then presented to allow students to put
their skills into practice.
Food and nutrition 5 41

Teacher’s notes
Warm-up
1 On the board, write: Closed questions and Open
questions. Ask students, in small groups, to select
one of the patients from page 28 and brainstorm
five questions for each heading to assess the
patient’s symptoms. This can be done as a team
game – the first team with ten correct questions
in a given time is the winner.
2 Ask students, in pairs, to take turns to roleplay
an assessment with their patient from page 28.
Nutrition
Vocabulary
1 Refer students to the food pyramid and ask
them, in pairs or small groups, to brainstorm
names of food stuffs they see. Depending on
your group, you may wish to add a competitive
element and divide the group in two. The
winning group is the one that finds the most
food items in a given time.
Depending on your group, they may know
certain food stuffs as opposed to others.
Ask students, individually or in pairs, to label
the sections 1–4 of the pyramid with the words
from column 3 of the table. Ask them to compare
their ideas with a partner, then come together as
a group to check.
If your students are experienced nurses, ask:
When might a nurse use the pyramid with patients?
What is your experience of this type of chart? What
other types of diagram might be used instead?
(Nurses use food pyramids to give advice to
patients on diet, to show them the proportion of
each food group they should be eating. Other
examples: eat-well food plate/a pie chart.)
Ask students to add typical food stuffs/dishes
from their own culture to the sections of the
3 Ask students, individually or in pairs, to refer
pyramid. Come together as a group to exchange
ideas.
1 fats, oils, sweets
2 meat, fish, dairy products, beans, eggs
3 fruit and vegetables
4 potatoes, rice, cereal, pasta, bread
2 Refer students to the table and ask them,
individually or in pairs, to use the words in the
box to complete the statements in column 2
about the different food groups. Come together
as a group to check.
If your students are pre-experience nurses,
encourage them to make use of the information
in the third column to help them complete the
table.
1 energy 2 build 3 digest 4 bones 5 fight
6 repair 7 skin
Language
More confident students can complete 3 (and 4)
before referring to the Language box. They can
then use this as a means of checking their
existing knowledge of the target structures.
For less confident students, write headings: a
and an on the board and ask them to brainstorm
food stuffs for each column. Ask: When do we use
‘a’ and when do we use ‘an’? (A is used in front of
countable nouns beginning with a consonant, an
with countable nouns beginning with a vowel.)
Countable and uncountable nouns
Draw a two-column table on the board. Do not
label the columns but write in column 1 biscuit,
egg and in column 2 water, sugar. Ask students
to add two more food items to each column
and ask a stronger student to give each column
a title (Countable and Uncountable). Ask: What is
the difference? (It is possible to count the nouns
in column 1 but not those in column 2.)
On the board, write: some, a lot of, How much?,
How many? Ask students to put these into the
correct columns. (Some and a lot of appear in
both columns. How much? in column 2 and How
many? in column 1.)
Remind students they can say a piece of cheese, a
bottle of water – the phrases in bold are
countable.
Give students time to assimilate the points
covered in the Language box.
back to the pyramid and add foods to the two
columns.
Food and nutrition 5 42
 Suggested answers Variation
Countable: some sweets, some crisps, some Ask students, in small groups, to discuss the
sausages, a yoghurt, a chicken, some nuts, following questions: Why (do you think) is it
some eggs, some peppers, some carrots, important to understand the dietary habits of your
some tomatoes, a lettuce, a cucumber, an patient? Give examples of the dietary habits of a
aubergine, some mushrooms, an orange, an culture/religious group that you know well.
apple, a bunch of bananas, a pineapple, some
grapes, some potatoes, some biscuits
Uncountable: some olive oil, some chocolate,
some fish, a glass of milk, some cheese, some
bacon, some broccoli, a bunch of celery, some
rice, some pasta, some cereal, some bread

4 Refer students to the photos of the four women

and ask them to read the texts and match the
photos to the correct text.

a3 b4 c1 d2

5 Ask students, individually or in pairs, to reread

the texts and underline the best word in each
case. If necessary, do the first answer as a group.
Encourage students to make use of the
information in the Language box if they are
unsure.
Check students understand: fussy, tofu, spicy,
papaya, pineapple, shellfish.

1 1 a 2 any 3 a lot of 4 much 5 a lot of

2 1 a 2 much 3 many 4 a 5 some
3 1 any 2 any 3 some 4 a lot of
4 1 an 2 much 3 any 4 any 5 a lot

Writing
6 Ask students to write a short paragraph to
describe their own diet and eating habits.
Encourage them to use the target language and
structures.
Encourage less confident students to use the
texts in 5 as a model. Students may wish to work
in pairs or small groups for collaborative
writing.

Extra activity
Ask students to prepare a brief presentation to
deliver during the next class. Ask them to find
a food pyramid or something similar that
reflects typical eating habits of a patient/a
child/a culture that they don’t know well.
Alternatively, they research and design a food
pyramid to represent typical food intake and
quantities for one of the above. They present
the information on PowerPoint slides, if
possible, as a case study during the next class.

Food and nutrition 5 43

 Nutritional status
Vocabulary
1 If your students are experienced nurses, ask:
What is the Body Mass Index used for? How is it
measured? (The Body Mass Index or BMI is used
to decide if a patient’s weight is healthy,
compared with their height squared.)
Elicit/Pre-teach adjectives that nurses might use
to describe a patient’s weight: overweight, obese,
underweight.
It is important to point out that the adjective fat
is not used in a medical context – use of
overweight or obese and variations of these are
used instead.
Ask students, individually or in pairs, to read
the text about BMI and complete the statements
using the words in the box.
Remind students that numbers with decimal
points are pronounced like this: twenty-five point
five. (In some languages a comma is used instead
of a point.)
Ask: How do you think nurses might calculate the
BMI of a patient who is not able to stand? Is the BMI
suitable for measuring children/a baby?
Answers: Ask the patient to open their arms
outstretched at shoulder height and measure the
distance between the tips of the middle fingers –
this measures the height of the patient. Use mid
upper arm circumference (MUAC)
measurement. If the MUAC is less than 23.5 cm,
the BMI is likely to be less than 20 kg/m2
(patient is likely to be underweight). If MUAC is
more than 32.0 cm, the BMI is likely to be more
than 30 kg/m2 (patient is likely to be obese). The
BMI and MUAC measurements are only suitable
for adults.
1 underweight 2 overweight 3 obese
Listening
2 ► 35 Tell students they are going to hear Nurse
Sam McCarthy assessing Alain’s nutritional
status. Ask students to listen and complete the
Nursing Assessment form. If necessary, ask
them to familiarise themselves with the
assessment form before listening.
Check understanding of: allergies.
a 22.4 b peanuts
c last night, 10pm, bowl of soup and toast
3 Ask students to read Alain’s food journal and
then complete the statements about his
nutritional status based on this and the
information in the assessment form.
1 slightly underweight 2 gain weight
3 normal weight 4 doesn’t eat enough
Speaking
4 Refer students to Alain’s food journal and ask:
What do you think a food journal is used for? Who
fills in the journal? (Patients suffering from
weight problems may be asked to fill in a food
journal so that the nurse or nutritionist can
advise them on a weight loss/gain plan if
necessary.)
Ask students, individually or in pairs, to read
through Alain’s food journal and answer
questions 1 and 2. Come together as a group to
check. See 5 below for complete answers.
5 ► 36 Tell students they are now going to hear
Nurse Sam assessing Alain’s food intake. Ask
them to listen and compare her advice with their
own.
Less confident students could complete 6 before
listening to the audio.
Suggested answer
Assessment and advice: Bad points: calorie
intake is very low; it’s not a balanced diet; lacks
sufficient protein, carbohydrates and fibre; he’s
skipping breakfast (after eight to ten hours
without food, the body needs energy); he drinks
too much coffee
Good points: brown bread is a good source of
fibre; he eats three portions of fruit and
vegetables a day; his only snack was a piece of
fruit
6 Ask students, individually or in pairs, to
complete the sentences using the words in the
box. Play the recording again. Come together as
a group and check. Check understanding of:
snack, balanced, skip, source.
1 intake 2 balanced 3 lack 4 skipping
5 energy 6 source 7 snack
Food and nutrition 5 44
7 ► 37 Ask students to listen to the final part of
the assessment and complete the statements
about Alain.
If your students are experienced nurses, ask: Do
you find it difficult to follow a good diet at work?
What kind of food do you eat while at work/on shift?

nurse, fruit/vegetables/yoghurts/avocados

Reading
8 Ask students to read through the case history
and food journal for patient Annabelle Driver.
Ask some comprehension questions: What kind
of surgery did Annabelle have recently? What is
her job? What do we learn about her family life?
What is her general health like?
Ask students, individually or in pairs, to write
six sentences about her food intake.
If necessary, elicit/pre-teach: varicose vein
(surgery), deprived area, recover, depression, single
parent.

Suggested answers
1 Her calorie intake is very high and most of
the calories come from fat and sugar sources
or complex carbohydrates.
2 She has a very unbalanced diet. She eats too
many high-calorie and high-fat foods and
sugary, carbonated drinks. Her servings are
also larger than average. She does eat three
portions of fruit but no vegetables (except
potatoes in the form of chips). Her diet also
lacks sufficient protein.
3 The patient often snacks on high-calorie and
high-fat foods. Her calorie intake for these
snacks is also very high.
4 She skips breakfast which is the most
important meal of the day.
5 She lacks sufficient fibre in her diet.
6 The patient should eat more fibre, vegetables
and protein.

Speaking
9 Ask students to write their own food journal and
then present an assessment of their food intake
to the rest of the group, using the same
headlines as for Annabelle.
Students may wish to write notes before
presenting to the rest of the group.

Food and nutrition 5 45

 Food allergies and intolerances
Speaking
1 Ask students, in pairs, to discuss the questions.
Come together as a group to brainstorm possible
answers. Avoid correcting at this stage as
answers will be supplied in 4. Ask: Who suffers
from allergies, other than food allergies? What are the
symptoms?
If your students are experienced nurses, ask:
What is your experience of dealing with patients with
(food) allergies?
5 Ask students, in pairs, to read the sentences out
Reading
2 Tell students they are going to read a patient
education leaflet about food allergies. Before
they read, ask them, individually or in pairs, to
match the words 1–4 to the correct definitions
a–d. Come together as a group to check.
Alternatively, you could ask more confident
students to do 3 first, without correcting at this
stage – allow them to read the target language in
context first and encourage them to deduce the
meaning from context.
6 ► 38 Ask students to listen to the recording
1c 2a 3d 4b
3 Ask students, individually or in pairs, to
complete the first part of the patient leaflet using
the words in 2. Check comprehension of: release,
histamine, gastrointestinal tract.
1 adverse 2 immune system 3 harmful
4 antibodies
4 Before students read the second part of the
leaflet, write two additional questions on the
board: When do symptoms typically appear? When
should a patient call the doctor? Remind them of
the questions in 1, then ask them to read and
correct their responses to 1. Come together as a
group to check.
Check understanding of: rash, eczema,
consciousness, disappear.
Most common food allergies: fish, shellfish,
peanuts, milk, eggs, wheat, nuts, soy
Symptoms: tingling sensation in the mouth,
rash, swelling, eczema, abdominal cramps,
diarrhoea, vomiting, swelling of the tongue and
throat, wheezing, breathing difficulties, fall in
blood pressure, loss of consciousness, death
Extra activity
In small groups, students answer these
questions:
1 Name two ways that a food allergy can be
diagnosed.
2 How do these tests work?
3 What advice would you give a patient
suffering from a food allergy?
e.g. It might be a good idea to …, Can I suggest
you …
Pronunciation
loud and then underline the stressed syllable in
the words in bold. Encourage them to divide
each of the words in bold into syllables first as
this may help them distinguish the sounds.
Depending on your group, you may wish to
read out the first sentence aloud as a group
chorus, to discourage embarrassment. Avoid
checking at this stage.
On the board write: allergy and allergic. Ask a
stronger student to underline the stress in each
case (allergy / allergic).
and check their answers. Then play the
recording again, asking them to listen and repeat
the stress pattern they hear.
Play the recording several times until you are
happy students are able to reproduce the
same/approximate stress pattern.
Students may already know some of these
words from their own language, but will tend to
place the stress in the wrong place in English.
Ask them to compare stress patterns in their L1.
1 allergies 2 allergic 3 abdomen
4 abdominal 5 respiratory 6 respiration
Extra activity
Ask students to practise reading the patient
leaflet in 3 aloud as a group for controlled
practice of the stressed words.
Then one by one, ask students to read the
leaflet aloud. Explain that when you say ‘Stop’
the next student should continue. Make sure
that all the students are given an opportunity
to practise the target word stress. If necessary,
repeat the activity to ensure this takes place.
Food and nutrition 5 46
 Speaking
If your students are pre-experience nurses, you
may prefer to set 7 and 8 as self-
study/homework. It is not necessary for
students to have completed 7 and 8 in order to
carry out the rest of the activities in this section.
7 Ask students, in pairs, to discuss questions 1–3.
Ask them to join up with another pair to
compare their answers. Avoid correcting their
ideas at this point.
Pre-experience nurses may find this activity a
little challenging. Reassure them that this is not a
test.
If your students are experienced nurses, you
could ask: What are the symptoms of diabetes? What
is the difference between Type 1 and Type 2 diabetes?
11 Ask students, in pairs, to take turns to practise
Reading
8 Tell students they are now going to read a
definition of diabetes taken from a reference
book for nursing students. Ask them to read and
find the answers to the questions in 7.
Check understanding of: hormone, pancreas,
respond, thirsty, link.
1 Diabetes is a condition where the body is
unable to produce glucose, a sugar which the
body uses for energy. The body has a very
high blood sugar. The level of glucose is
usually controlled by the hormone insulin.
2 Type 1 diabetes is caused when the
pancreas doesn’t create enough insulin. Type 2
diabetes is caused because the body is not
able to respond to the insulin in the body.
3 Type 1 diabetes can be controlled with
insulin. Type 2 diabetes can be controlled with
diet and exercise.
questions. Ask them to compare their answers in
pairs, then come together as a group to check.
Note that the answer to 4 is contained in the
illustration, not in the audio script.
1 the patient’s blood sugar level 2 top of the
finger (any) 3 test strip 4 106, this shows the
level of glucose in the blood
Extra activity
Refer students to audio script 39 on page 75
and ask them, in pairs, to practise the dialogue.
This allows them to ‘see’ the target language in
context, thus reinforcing what they have just
heard.
Speaking
taking their partner’s glucose level using the
prompts 1–6. Tell them they can also make use
of the images in 9 to help them structure their
roleplay.
Encourage them to use staging words from Unit
4. On the board write: firstly, then, next, finally.
Ask students to brainstorm other staging words
that could be used when explaining a medical
process to a patient. Ask: Why are staging words
useful? What else is important when explaining a
process to a patient? (Always keep patients
informed before carrying out the process. Pause
slightly after each staging word. This makes it
easier for the patient to follow the information
provided by the nurse – it divides up the
information into manageable chunks. It is also
important to use patient-friendly intonation.)
Students may wish to make notes first before
practising their dialogue.

Listening
9 ► 39 Tell students they are going to listen to a
student nurse, Joely Thomas, learning how to
administer a blood sugar test. Ask students,
individually or in pairs, to label the diagram
using the words in the box. Point out there are
two answers required for c.

a screen b finger c drop of blood, lancet

d test strip e plaster f glucometer
g blood glucose chart

10 Refer students to questions 1–4. Ask them to

listen to the recording again and answer the

Food and nutrition 5 47

 Advice on diet
Vocabulary
1 Ask students, individually or in pairs, to look at
the containers and quantities and match them to
the correct word. Encourage students to use
their knowledge of general English to help them.
Ask them to compare answers with another pair
before coming together as a group to check.
Ask students to brainstorm two or three
examples for each of these, e.g. bottle of tomato
sauce, slice of bread, etc.
1 can 2 carton 3 glass 4 tablespoon
5 packet 6 slice 7 piece 8 stick 9 bottle
10 segment
Listening
2 ► 40 Ask: What is a school nurse? What do you
think their role is? Does this post exist in your
country/place of work?
Tell students they are going to hear Maggie, a
school nurse, giving advice on nutrition to a
group of adolescents. Ask students to listen and
tick the quantities/containers they hear.
Reassure them it is not necessary to understand
the whole recording on first hearing as they will
have a chance to listen to the recording again
later.
slice, segment, portion, carton, stick, a lot of,
packet
3 Refer students to the questions 1–5. Ask them to
listen and answer the questions. Encourage
students to take notes as they listen.
1 Eat five portions of fruit and vegetables a
day.
2 one apple, fourteen cherries, two slices of
mango, eight segments of canned grapefruit,
one tablespoon of raisins, two figs, 150 ml of
fruit juice
3 three sticks of celery, three tablespoons of
cooked/canned/frozen vegetables
4 These do not count as a portion of
vegetables.
5 Be careful of them because they only count
as one portion of vegetables and contain a lot
of salt and sugar.
Extra activity
On the board, write the following list:
carbonated/sugary drinks
sugary snacks: chocolate, cookies, sweets, etc.
salty snacks: crisps, peanuts, pretzels, etc.
ready-made meals, takeaway foods
high-calorie desserts: chocolate mousse, carrot cake
red meat
fried food: chips, fried fish, etc.
skipping breakfast
snacking between meals
eating after 8pm
1= easy to stop 2 = a little difficult, but I could stop
3 = very difficult to stop
Ask students, individually, to look at the list
and, using the scale 1–3, decide which dietary
habit(s) they would find difficult to change.
On the board, write:
… are cheaper/more practical than …
I want to stop eating ..., but it’s not easy.
I’ve tried to stop, but …
My partner loves … and it makes it more difficult to
stop.
Ask students, in pairs, to discuss their
responses, using these phrases.
4 ► 41 Tell students they are now going to listen
to nurse Brad Tyler giving advice to three of his
patients, Lena, Frank and Edith. Refer students
to statements 1–3 and ask them to listen and
complete the statement for each patient.
Encourage students to use the information in the
statements to help them guess the rest. Play the
recording again if necessary.
1 gain weight, build up her appetite
2 improve his diet
3 lose weight/take exercise
5 Ask students to listen to the recording again and
complete the nurse’s suggestions. Students
should then match each suggestion to the correct
patient, Edith, Lena or Frank. Ask them to
compare their answers with a partner, before
coming together as a group to check.
1 walking, dog E
2 eat, often L
3 eating fish F
4 exercise, lose weight E
5 drink, water L
Food and nutrition 5 48
 Language
Giving suggestions and advice
Refer students, in small groups, to the
Language box and ask them to note the form in
each case.
Answers: should (not) + infinitive;
How about + -ing; Can I suggest you + infinitive;
It’s advisable/important to + infinitive
Refer students back to 5 and ask them to
indicate what type of advice is being given in
each case (tentative or strong suggestion).
Answers: 1 tentative 2 tentative 3 tentative
4 strong 5 strong
Still focusing on 5, ask: When do we use the three
ways of giving suggestions and advice?
Answer: should (not) + infinitive: to give a
strong opinion; How about + -ing/Can I suggest
you + infinitive: to encourage the patient to take
responsibility and/or take part in the decision-
making process; It’s advisable/important to +
infinitive: to give strong advice in an
impersonal way – this makes it sound less
threatening to the patient.
Give students time to assimilate the points
covered in the Language box.
6 Ask students, individually or in pairs, to rewrite
the suggestions 1–6 by replacing should with
another expression from the Language box.
Alternatively, you may wish to ask a stronger
student to decide if the pieces of advice require
tentative or strong suggestions. Check this first
before asking the students (individually or in
pairs) to carry out the activity. Come together as
a group to check.
Suggested answers
1 It’s advisable to only eat red meat once a
month, according to government advice.
2 It’s advisable to eat breakfast: it’s the most
important meal of the day.
3 Why don’t you play football with your kids in
the park?
4 It is important not to drink more than one cup
of coffee at night.
5 How about going swimming if this is your
favourite sport?
6 Can I suggest you reduce the number of
complex carbohydrates in your diet?
Extra activity
Ask students, in pairs, to write three or four
more pieces of advice using should + infinitive.
Ask them to pass their suggestions to another
pair, who rewrite them in the appropriate form
– tentative or strong.
Variation: Write the advice on cards. Divide
each small group into two teams. Each player
turns over a card and reads out the piece of
advice to another team member, who then
offers their own stronger/tentative version.
Teams win a point for each correct answer.
Writing
7 Refer students back the three patients in 5. Ask
them to write two pieces of advice for each of
the three patients.
Speaking
8 Put students in pairs and refer Student Bs to
page 68. Ask the pairs to read through their
instructions and the relevant case history and
food journal carefully and then carry out the
roleplay.
If necessary, go through the case histories and
food journals in detail first as a group before
asking students to roleplay the scenarios.
Students then swap roles.
Preparing for the next unit
In preparation for Unit 6, suggest the following to
your students:
• Compile a list of words related to patient care
that you already know in English, e.g.
toothbrush.
• Think about all the different ways a nurse
may be required to assist a patient on a daily
basis.
• Do some (online) research into how to treat
and dress minor wounds.
Food and nutrition 5 49