Nutrition Analysis Project

ANALYSIS
My subject is Brenda Tursugian, a 43-year-old woman who is 52 (1.6
m), currently weighs 187 lbs (85 kg). Her current BMI is 33 (Obese I).
She had a gastric band placed 12/2009 at which time her BMI was 51
(Obese 3); her weight just prior to gastric banding was 287 lbs (130 kg)
see back of page 1 on Form B for hand calculations. Brenda has
successfully lost a total of 100 lbs so far and has successfully
maintained her weight loss. Brenda came to me for help losing her last
47 lbs to reach her goal weight of 140 lbs (set by Brenda and her
surgeon). Brendas job requires her to travel to different clients each
week, sometimes commuting up to 2 hours or more one way. She is
usually at a client location Monday-Thursday and works from home on
Friday. While Brenda is not an athlete, she strives to stay active. She
does Tae Kwon Do (high intensity) 3 times/week and also goes to
Zumba class 3 times/week (medium-high intensity). The week Brenda
tracked her diet and activity; she was out of town at a client and was
not able to attend Tae Kwon Do or Zumba.
SUMMARY
Food Guide Analysis: Brendas intake of Grains was just below
adequate (88%, or 4.4 oz out of the recommended 5.0 oz). Brenda
consumed 100% of her daily-recommended amounts for Vegetables
(2.0 cups). Brenda only consumed 23% of her recommended amount
of Fruits (0.3 cup out of the recommended 1.5 cups). Brenda only
consumed 50% of her daily Dairy recommended amount (1.5 cup out

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of the recommended 3.0 cups). According to MyPlate, Brendas

protein intake was 213% of her recommended amount (10 oz out of
the recommended 5.0 oz). While this seems excessive, due to
Brendas gastric band, her doctor recommends a daily total of 80-100g
of protein. Consuming 10 oz of protein puts Brendas intake at
70g/day, which is below her doctors recommendation (See back of
page 1 on Form B for hand calculations).
The foods Brenda consumed that were high in Total Fat were: Big Mac
(32.8 g), Coconut Milk (48.2 g), and Lamb Meatball (46.9 g). Foods
high in Saturated Fat were Coconut Milk (42.7 g), Lamb Meatball
(20.4 g), and Cream of Cauliflower Soup (13.6 g). The Big Mac also
came in high for Trans Fat, having 1.3 g. The foods Brenda ate that
were high in Sodium were: Grilled Cheese Sandwich (1177.9 mg),
Mango Chutney (1090.0 mg), Potato Pattie (1078.0 mg), and Big Mac
(1007.4 mg).
Brendas intake of Grains, Fruits, and Dairy were below the
recommended amounts. During interview, it was learned that Brenda
is not currently taking any Vitamin or Mineral Supplements. Since
Brenda underwent gastric banding, she is at risk for nutrient
deficiencies due to the restrictive nature of her surgery. That said,
since her surgery is only restrictive in nature (vs. malabsorptive in
nature), it is possible for her to get her nutrients from food, assuming
she can consume adequate amounts of food over the course of a day. I
believe this is attainable for Brenda. I recommend that Brenda have
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her blood levels check to know where she stands with Vitamin and
Mineral levels. This will help determine if Brenda needs to start taking
supplements to ensure adequate micronutrient intake.
Brenda and her doctor have set a goal weight of 140 lbs. She now
weighs 187 lbs, giving her a total of 47 lbs more to lose. Losing at a
rate of 2 lbs/wk, it will take Brenda 24 weeks (just short of 6 months) to
meet this goal weight. In order to lose 2 lbs/wk, Brenda will have to
consume 7000 kcal/wk, or 1000 kcal LESS per day. I calculated
Brendas BMR to be 2014 kcals; using a PAL of 1.27 as a coefficient,
her TEE calculates out to be 2615 kcals. In order to lose 2 lbs/wk,
Brenda will need to consume 1000 kcal/day LESS than her calculated
TEE, giving her a total of 1615 kcal/day. Her average kcal intake for
the three days tracked was 1914; thus, she will need to decrease her
kcal intake by approximately 300 kcals. During interview, it was
learned that Brenda often skips meals (most notably: breakfast). In
order for her to get a total of 98 g of protein per day (per her doctors
recommendation) and stay within her caloric intake required to lose 2
lbs/wk, I have come up with a manageable plan that will be easy for
her to follow. I recommend that Brenda consume 6 small meals
throughout the day. Due to the fact that she has a gastric band, she is
only able to eat small amounts at one sitting. Consuming small meals
will help ensure that she 1) does not skip meals and 2) meets her total

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caloric needs each day. My recommendation is to have the following

break down of Macronutrients each day:

PRO = 98 g/day X 4 = 392 kcal/1615 = 24%

CHO = 206 g/day X 4 = 824 kcal/1615 = 51%
FAT = 45 g/day X 9 = 405 kcal/1615 = 25%

Each of Brendas small meals should consist of the following

breakdown (approximately):
PRO = 98 g/6 = 16.5 g X 4 = 66 kcal
CHO = 206 g/6 = 34.5 g X 4 = 207 kcal
FAT = 45 g/6 = 7.5 g X 9 = 68 kcal Total: 341 kcal/meal
Brenda is also consuming less than the recommended amounts for
grains, fruits, and dairy. By adding 1 additional serving of grains,
Brenda can meet her recommended amount. This means 1 slice of
whole grain bread, cup brown/wild rice, 1 cup enriched cereal or
oatmeal. Brenda needs to double her intake of dairy products.
Consuming an inadequate amount of dairy could lead to a deficiency in
calcium and Vitamin D. Adding one additional serving of dairy to each
meal (such as 1 cup low-fat milk, cup low-fat cottage cheese, cup
pudding made with milk, or low-fat cheeses) can help her meet the
recommended amount. Additionally, as Brenda is 43 years old, she
needs to consider her bone mass. Consuming adequate amounts of
calcium will help preserve her bone mass. Brenda is getting only 23%
of her recommended amount of fruits on average. She should consider
adding fruit to each of her 6 small meals to help her get the

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recommended daily amount (1.5 cups). By adding a handful of

strawberries, small apple, an orange, banana or kiwi to each meal,
Brenda will be able to meet her goal of consuming adequate fruits
each day. Brenda also needs to increase her water intake, especially
on the days she goes to Tae Kwon Do and Zumba classes. The most
water she drank for the three days she tracked her intake was 5 cups
(8 oz each) which is a total of 1.18 L. Lastly, since Brenda often has
long commutes to and from work, I have given her a couple of ideas for
easy, portable breakfast meals. These simple breakfast meals be can
prepared ahead of time and she can grab and go. This will help her
NOT skip breakfast like she often does.
*All calculations are on the back of page 1 of Form B

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Dietary Recommendations For Brenda

See your Primary Care Physician and get your blood levels
checked. This will help determine if you need to supplement

your diet with Vitamins and Minerals.

Make sure you eat breakfast! This meal literally breaks the fast
when you skip breakfast, your brain and body will not have
enough glucose to function properly. Also, when you skip
breakfast, your body will store the food you eat as fat from being

in a starved state (as a survival mechanism).

Eat 6 small meals, evenly spaced throughout the day (such as:
8am, 10am, 12pm, 2pm, 4pm, 6pm). This will help keep your

blood glucose levels steady throughout the day.

Recommended breakdown for each small meal:
PRO = 98 g/6 = 16.5 g X 4 = 66 kcal
CHO = 206 g/6 = 34.5 g X 4 = 207 kcal
FAT = 45 g/6 = 7.5 g X 9 = 68 kcal
Total: 341 kcal/meal
SPECIFIC FOOD GROUP RECOMMENDATIONS

Your intake of Grains was just under the recommended amount

(4.4 oz/5 oz). Adding just 1 additional serving of whole grains will
put you right in the zone. 1 slice whole wheat bread, cup

brown/wild rice, cup quinoa, cup oatmeal.

Keep up your Vegetable intake as normal you are spot on
here! Dont forget to vary your veggies: dark green, orange, dry

beans & peas, etc

Increase your Fruit intake! Currently you are only getting 23% of
your recommended amount of fruits (0.3 cup/1.5 cup). Add 1

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serving of fruit to each of your 6 small meals to help you meet

this intake goal. 1 apple, 1 orange, 1 kiwi, 1 cup strawberries, 1

cup grapes, cup raisins, 1 banana, etc

Currently you are only getting 50% of your recommended
amount of Dairy. Start including 1 serving of dairy to each
meal: 1 cup low-fat milk, cup low-fat cottage cheese, low-fat

cheese, cup yogurt, cup pudding made with milk.

While you are above the recommended daily amount of Protein
(for the average healthy person), your doctor is recommending
80-100 g/day. You are currently getting about 70 g/day (1 oz of
protein contains about 7 g of protein). Increasing your protein to
14 oz/day will give you 98 g of protein. Use your protein drinks
to help you reach this goal. Each of your protein drinks supplies

you with 20 g of protein!

Drink more Water!!! Your highest intake of water for the 3 days
tracked was 1.18 L you should be getting a minimum of 2-3
L/day (68-102 fluid oz). On the days you go to Tae Kwon Do and
Zumba, consume an additional 1-2 L (34-68 fluid oz).

Some easy, portable breakfast ideas to make ahead and grab and
go:
Make individual crustless quiches in a muffin tin using egg, and
various veggies, such as spinach, kale, bell peppers. Add some low-fat
cheese to get in some dairy.

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Breakfast #1:

crustless quiche w/egg /veg & l/f cheese

150 kcal
1 medium banana

105

1 protein drink (20g Pro)

120

kcal

kcal
Total:

375

kcal
Breakfast #2:

whole wheat bagel

140

kcal
1 Tbsp cream cheese

50

cup sliced strawberries

23

kcal

kcal
Protein drink (20 g Pro)

120 kcal
Total:

333

kcal

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Reflection:
I loved doing this project! I have actually done this same type of
project 4 other times for other classes. The difference this time is I am
able to practice and apply what I am learning AND I was able to apply
it to someone who has had gastric band surgery and needs help losing
her last 47 lbs. This is what I want to do as a registered dietitian!
Doing this assignment made me remember WHY I quit my job as a
Bank Auditor (making decent money) to go back to school and start a
new career. Not only was I able to use my academic knowledge, but I
also used my personal experience as a bariatric patient. I feel this
personal experience gives me an advantage working with bariatric
patients that most Registered Dietitians do not have.

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References:
www.nutricalc3.mheducation.com
www.myplate.gov

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