Client name: Veronica GeorgeDOB: 9/73Age: 40Sex: FemaleEducation: Bachelor’s DegreeOccupation: Secretary of local high schoolHours of work: 8-5 five days a weekHousehold members: Husband (40 yr.), two children; Rachel (9 yr.) and Michael (7 yr. old)Ethnic Background: CaucasianReligious affiliation: ChristianReferring physician: D. D. Strong, MD (family medicine, University of Health Service)

Other Information: Working mother of 2 children. Works at an office job from 8-5, five days a week and takes care of children on the weekend. Claims to have little time for physical activity and is limited to what she can eat since her home is far away from where she works. Gained weight during the pregnancies and has not been motivated to lose the weight. Husband works from 8 to 6 pm and has little time to spend with the family. Has obtained a primarily fast-food diet and convenient food since she does not feel that she has enough time. She is tired when she comes home from work and after picking up the kids that she doesn’t want to work out or cook. She admits to binge eating due to stress and feeling depressed. Husband does little to help around the house.

Anthropometric Measurements:

Height: 5’6” Weight: 200 lbs.BMI: 32 kg/m2

Class: Obese class I IBW: 130 lbs.TEE for overweight/ Obese Females aged 19 and older (Table 14. 3)488-7.95 x age + PA (11.4 x weight (kg) + 619 x height (m)= 2,570 kcalsWaist Circumference: 45 inches: High risk of type 2 diabetes, hyertension, dyslipidemia, coronary artery disease, and metabolic syndromeBP: 140/90 mm Hg

Client History:

Biochemical Data:

Laboratory Measurement

Normal Range Measured Value

Serum Glucose (mg/dL)

70-120 190 H

HgBA1C1 (%) 4.8-7.8Total Cholesterol (mg/dL)

140-199 220 H

LDL (mg/dL) < 130 140 HHDL (mg/dL) 40-85 20 LTriglycerides (mg/dL) 35-160 170 HBlood Pressure (mm Hg)

<120/<80 140/9

Visceral protein AssessmentHematological Assessment

Food/ Nutrition Related History:

24-hour Recall

Breakfast: McDonald’s Bacon Egg and Cheese Biscuit and Hasbrowns (1 oz)AM Snack: Skittles ( 1 2 oz package)Lunch: Burger King Whopper with 1 slice of american cheese, 1 medium serving of french fries, 1 small (12 fl oz) Vanilla ShakePM Snack: 1 glass of water, 1 5 oz bag of barbecue-flavor potatoe chipsDinner: Taco Bell Soft taco with beef, Coke (1 16 fl oz bottle)HS Snack: Chocolate Ice Cream (1 cup), Chocolate chip cookies (10 cookies)

No nutrition education other than health class in high school.Food allergies/intolerances/aversions: Does not like vegetablesFood purchase/prepartation: Fast food/ rarely make meals in homeVit/min intake: None

Physical Activity:Very littleSits at desk all dayRarely sits down for meals other than at a fast-food place or deskDrives children to soccer practice and schoolSpends free-time watching television or reading

Diagnosis:

1. Excessive energy, fat, sugar intake related to Obese class 1 as evidence by BMI of 32 kg/m2.

2. Nutrition related knowledge deficit related to minimal nutrition education as evidence by 24-hour recall and caloric dense foods.

Nutrition Intervention:- Nutrition Education

o Grocery Market Lessono Cooking Lessons and Food Prepo How to read a Nutrition Label

- Diet plan food logs- Decrease energy intake and increase physical activity gradually

o Initial weight loss goal of about 10% of thir body weight over a six month period.

o 1-2 pounds lost per weeko reduce energy intake 500-1000 kcal per dayo Excerise program:

10-15 minutes 2x day Group fitness classes, walking groups, swimming classes

- Assess williness and readiness to lose weight- Assess Behaviors

o Has the individual sought weight loss on her own initiative?o What events have led the patient to seek weight loss now?o What are the patient’s stress level and mood?o Does the individual have an eating disorder, in addition to obesityo Does the individual understand the requirements of treatment and

believe that she canfulfill them?o How much weight does the patient expect to lose? What other

benefits does she anticipate?

Prognosis- If obesity and lifestyles habits do not change, there is an increase in risk for a

number of chronic diseases.- Life expectancy for females with a BMI greater than 30 kg/m2 is 40 years/ 7.1

years of life expectancy.- Life expectancy decreases with smokers- Excess mortality is greater with more severe obesity and with earlier onset

of obesity.

24-Hour Diet Recall

Goal Rewards

- After first 1-2 lbs. lost = buy a new piece of jewelry- After second 1-2 lbs. lost = buy new piece of clothing- After third 1-2 lbs. lost = buy new workout gear item- After fourth 1-2 lbs. lost = Receive new water bottle and

gift card to Store of choice - After fifth 1-2 lbs. lost = Receive free fitness pass to local

gym for a class of choice (for a month)

Food Log

Keep a journal of food items and physical activity done each day. Include portions, servings, and how it was made (fried, baked, grilled?) Write how you feel after each meal/activity and how you feel at the end of the day. You can calculate calories using phone apps, and some websites.

What happens next?

- Schedule visits every 2 weeks, or make call ins, email.- Join support groups, or group fitness classes.- Feel free to contact me with any questions and concerns.

Sample Menu

Breakfast1 Whole Wheat English muffin

1 scrambled egg2-3 slivers of avocado

1 Tbsp. of salsa1 cup of skim milk

Snack1 Banana

1 Tbsp. peanut butter

Lunch2 slices of wheat bread1-2 slices of lean turkey

1 Tbsp. of mustard2 slices of tomato1 cup of carrots

2 Tbsp. of hummus1 can of seltzer water

Snack1 small bag of Veggie Chips

Dinner1 cup Steamed Carrots and Broccoli

2 oz. of Grilled Chicken Breast1 roasted potato with (1 Tbsp. Olive Oil, basil, and pepper)

HS Snack1 Apple cut into slices

1 Tbsp. of Chocolate Syrup

Foods Recommended- Whole Fruits- Vegetables- Whole grain/whole wheat products-Brown rice - Grilled Chicken-Fish-Olive Oils-Dark Chocolate (moderately)-Water- Lean meats (Turkey, chicken)- Seasonings (Basil, Pepper, Cumin..)

Foods to Avoid- Butter/Margarine- Fried foods- High sugary drinks(soda, juices, flavored milk, flavored coffee drinks)- White rice- Baked goods(cookies, cake, brownies)-Excessive alcohol intake (no more than one drink a day)- High sodium meat (ham, hot dogs)-Mayonnaise

Additional Tips

Need Motivation?

There’s an App for that!

Whopper with Cheese Grilled Chicken with Cheese Salad with Grilled Chicken

Medium Fries Small Frie with an apple Apple slices

Coke decrease amounts gradually carbonated water (La Croix) Water

Ice Cream Frozen YogurtBanana Ice Cream--> Fruit and Yogurt

Vanilla Shake jr. Size shake Iced Coffee with cream/ no sugar added or make fresh fruit smoothie

Cookies Decrease amount of cookies gradually add whole fruits distract oneself if it is purely emotional Go to bed

- Blog about it- Pinterest- Get the family involved family activities- Ask a coworker to start walking with you during lunch or during breaks- Go walk with husband after dinner, get him on board with new diet changes.- Make a motivational bulletin board

- MyFitnessPal: Free, tracks what you eat, exercise, and calorie goals- Eat This Not That! Game- Fooducate- Nutrition Scanner- Moves: automatically tracks your everyday life and exercise. Just carry phone in pocket or bag

Helpful Websites

Eatright.org

Myplate.gov

Livestrong.com

Eating Well.com

Pinterest may not all be professional sources but good for recipe ideas, workout ideas, and motivation.

Sparkpeople.com

Don’t forget to have fun

References

"Academy of Nutrition and Dietetics." Academy of Nutrition and Dietetics. N.p., n.d. Web. 01 Apr. 2013.

"ChooseMyPlate.gov." ChooseMyPlate.gov. N.p., n.d. Web. 01 Apr. 2013.

"Clinical Knowledge Summaries." NHS. N.p., n.d. Web. 01 Apr. 2013.

"FitDay - Free Weight Loss and Diet Journal." FitDay - Free Weight Loss and Diet Journal. N.p., n.d. Web. 01 Apr. 2013

"Free Diet Plans at SparkPeople." SparkPeople. N.p., n.d. Web. 01 Apr. 2013.

"Healthy Fast Food." : Tips for Making Healthier Fast Food Choices. N.p., n.d. Web. 01 Apr. 2013.

"Home." Home. N.p., n.d. Web. 01 Apr. 2013.

"LIVESTRONG.COM - Lose Weight & Get Fit with Diet, Nutrition & Fitness Tools | LIVESTRONG.COM." LIVESTRONG.COM. N.p., n.d. Web. 01 Apr. 2013.

"Manage Your Weight." Weight Management. N.p., n.d. Web. 01 Apr. 2013.

"National Institutes of Health (NIH)." U.S National Library of Medicine. U.S. National Library of Medicine, n.d. Web. 01 Apr. 2013.

Nelms M, Sucher K, Lacey, K., Habash, D., Roth S. Nutrition Therapy and Pathophysiology. 2nd ed.Belmonte, CA: Thomson Brooks/Cole, 2010.