Michael Kaminski

Medical Nutrition Therapy DIE 3213

Michelle Elkadi, MS, RD, LD/N
October 26, 2015

1. Describe the stages of readiness for change, and identify where you
think she falls on this continuum. (4 points)
There are six phases to the Stages of Change Model: precontemplation,
contemplation, preparation, action, maintenance, and termination.
Precontemplation is the first phase and the individual has not thought about making
a change. The second phase is contemplation, in this phase the individual becomes
more aware of the benefits of changing but are also still aware of the negatives.
Preparation is the third phase where the induvial has taken some steps to begin the
desired change. The next phase is action which is when modifications have been
made and continue for less than six months. Maintenance is the phase where the
modifications from the action phase have continued longer than six months. Finally,
there is the termination phase when the individual no longer thinks about the
change and the modifications have become habit. 1
The client appears to be in the contemplation stage. She recognizes that there is
a problem and that she needs to make some modifications.
2. Calculate her BMI. How would you interpret it? (2 points) How does
her waist circumference measurement add to your assessment? (2
points)

[lbs/(in.)2] x 703= BMI= [178/(66)2] x 703=28.7

The clients weight being 178 lbs and a height of 56 tall places her BMI at
28.7; placing her in the overweight category, just below the threshold for being
considered obese. The fact that the clients waist is above 35 inches is concerning.
High BMI and waist circumference are considered precursors for heart disease and
obesity.1
3. What does her history of giving birth to heavier than average babies
suggest? (5 points
Normal weight gain in a healthy weight female should be 25-35 lbs
during pregnancy. The fact that the client gained 40-50 lbs per pregnancy
suggests that patient was at risk or suffered from gestational diabetes
mellitus (GDM). This is further supported by evidence that both births were
macrosomia births, resulting in a fetal birthweight over 4000g.
4. Does she meet the criteria for this syndrome according to the
National Cholesterol Education Panels Adult Treatment Panel III? (3
points) How is metabolic syndrome treated with diet and physical
activity? (3 points)
Currently the patient meets several of the criteria points according to the
National Cholesterol Education Panels Adult Treatment Panel III . The clients waist
circumference is greater than 35 inches, serum triglycerides levels greater than 150
mg/dL, HDL less than 50 mg/dL, and a fasting glucose greater than 110 mg/dL. The
panel states that the patient only needs to meet three out of the five points to be
considered to have metabolic syndrome and the client meets four of the five points.

Metabolic syndrome can be treated through weight loss with a combination of

both diet and exercise. Its suggested that the patient exercises for 30 minutes a
day and follow the DASH diet. Increasing physical activity will increase her HDL,
lower her LDL, decrease her BMI, and decrease her waist circumference. Overall
weight loss can also reduce insulin resistance, blood pressure, and risk for
developing diabetes. 1
5. What can you do to help her become motivated from within herself
to change her diet and exercise behaviors? (5 points)
Motivational interviewing would be helpful in motivating the client to change
her diet and exercise behaviors. Motivational interviewing focuses on the ability of
the client to identify discrepancies in behavior and then motivate them to change.
Empathy and reflective listening needs to be exercised by the nutrition counselor to
demonstrate acceptance and understanding of the clients needs to facilitate
changes. The nutrition counselor should invite new perspectives and allow the client
to find solutions to the problem. Self-efficacy can be supported by allowing the
client to try behaviors while the counselor is present. 1
6. Assuming she becomes ready to take action, identify some initial
steps that she might take to improve her diet. (5 points)
Assuming the client becomes ready to take action the first step should
be goal setting with the nutrition counselor. Goals should be relatively shortterm and easy to achieve. For example, a goal for the client could be to make
a healthy dinner four nights of the week or to have a healthy breakfast
planned for three days during the week. Next, the client needs to form an
action plan to help out the specifications of each goal. During the creation of
the action plan its important for the client to identify any barriers or
problems that could occur in order to be avoided.
7. What is the role of physical activity in weight loss and weight
maintenance? (3 points) How do aerobic activity, strength training,
and stretching all contribute to optimal weight management? (3
points)
Physical activity plays a large role in weight loss and weight maintenance.
Data demonstrates that weight-loss therapy improves physical function, quality of
life, and reduction in medical complications linked to obesity. The goal of weight loss
should be to prevent further weight gain and maintenance of a healthy long-term
body weight.
Evidence suggests adequate levels of physical activity should be 60 to 90
minutes daily. Positive results have been found in overweight and obese patients
that have participated in as little as 30 minutes of exercise. Resistance training or
weight training increase lean body mass allowing the body to use more of the
energy intake, while increasing bone mineral density. Aerobic exercise is vital for
cardiovascular health through elevated resting metabolic rate. Aerobic exercise also

aids in calorie expenditure, calorie deficits, and loss of fat during weight
management.1
8. What methods would you suggest she could use for self-monitoring?
(5 points)
The client should begin to keep a daily logs to help her with self-monitoring.
Daily records with the place and time of food consumption, calorie intake, and
energy expenditure. Other self-monitoring techniques include meal replacements
and structured meal plans.1

9. Make suggestions for handling family meals, special occasions, and

holidays. (5 points)
Holidays, family meals, and special occasions often involve large quantities of
unhealthy food in our society. Some suggestions for the client would be to bring
healthier options that are less calorie dense than traditional items. The client
should use a smaller plate if available and remember that portion control is
important for success. When home and cooking family meals the client should try
make familiar meals but remove excess calories using healthy food substitutes. For
example, the client could begin using fat-free dairy products when preparing meals.
Also, the client needs to understand that she might need to prepare two meals for
her family; one being a healthy and light meal for herself and another being more
her traditional cooking style. She should lead by example and try to not force
anything new upon her family.
10.
Write a PES statement based on her initial presentation. How
would you monitor and evaluate the effect of your interventions? (5
points)
Excessive caloric intake as evidenced by a triglyceride level of 189 mg/dL, a
LDL cholesterol level of 119 mg/dL, and a BMI of 29. 1,2
Monitoring of the client should be done with weekly lab draws, weekly weight
checkups, and a daily food journal. Evaluation criteria to consider would be a
glucose level between 70-110mg/dl, a gain in LBM, a HDL cholesterol level greater
than 50 mg/dl, and a LDL cholesterol level less than 100 mg/dl.
11.

Menu

(5 x6) +100= IBW = 130 lbs

Using the ideal body weight formula the client should weigh 130lbs.
According to Choose My Plates food tracker the client should be consuming
in the range of 1500-1800 kcal per day.3

Breakfast
2 medium slice Bacon,
pork, cooked
1 medium (7" to 7-7/8"
long) Banana, raw
1 cup Milk, low fat (1%)
1 cup Oat bran cereal,
cooked (no salt or fat
added)

Lunch
1 cup, cut stalks Broccoli,
fresh, cooked (no salt or
fat added)
1 medium breast Chicken,
breast, boneless,
skinless, baked
1 cup Rice, brown,
regular, cooked (with salt
and margarine)

Dinner
1 cup, baby carrots
Carrots, fresh, cooked,
glazed, no fat added
1 cup Milk, fat free (skim)
1 cup Quinoa, cooked
3 ounce(s), cooked,
boneless Salmon, baked
or broiled, without fat

Snacks
1 container (6 oz) Yogurt,
strawberry, fat free

References
1. Mahan LK, Escott-Stump S, Raymond JL. Krauses Food & the Nutrition Care
Process. St Louis: Saunders; 2012;24, 26, 166, 194, 198, 215-16, 452, 759,
907-8, 1067, 1082
2. Nelms M, Sucher KP, Lacey K, Roth SL. Nutrition Therapy and
Pathophysiology. Belmont, CA: Wadsworth; 2010
3. United States Department of Agriculture Choose My Plate Website.
https://www.supertracker.usda.gov. Accessed on October 30, 2015.