A Case Of My Patient John

A nutrition assessment is a detailed evaluation of both objective and subjective data related to an individual's food and nutrient intake, lifestyle, and medical history. Nutritional assessment is crucial to fully understand the patient’s condition and to develop a specific nutrition care plan. As my assessment will show, my patient John has been making some poor food choices as well as a lack of physical activity. John is an overweight male who is at a high risk for Type 2 diabetes, heart disease, sleep apnea, kidney disease, etc. With proper nutrition and exercise John has a chance to improve his quality of life.

John’s Demographic Information

John is a 45-year-old male, Caucasian, who lives in the Southeast US. He is married and has two children that attend middle school. John’s primary care provider has referred him to my nutrition and wellness center. John is concerned about his weight and feelings of lethargy. He is also concerned about his potential risk factors for heart disease. Upon John’s arrival, I collected the following clinical information: age is 45, height is 5’10”, weight is 255 lbs., and 36.6 BMI. Due to John’s BMI being 30 or greater, he is considered obese. He also lives a sedentary lifestyle with very little or no exercise at all. His unhealthy diet choices and sedentary lifestyle has increased his risk of potentially serious health problems such as Type 2 Diabetes, Heart Disease, High Blood Pressure, High Cholesterol, Stroke, and possibly even Cancer. Research shows that when you're obese, your overall quality of life may be diminished. You may not be able to do things you used to do, such as participating in enjoyable activities. You may avoid public places. Obese people may even encounter discrimination (Schlenker, 2010).

John’s Daily Dietary Intake

John has provided me with a typical day dietary intake. I have put together a table to demonstrate his average daily meals. Aside from making poor choices, John does not exercise portion control. He consumes foods that are high in sugar, cholesterol, sodium, and calories. John is consuming about 4,687 calories per day which is not surprising considering his poor food choices and the fact that is he obese (SuperTracker, 2017).

John’s Daily Minerals and Vitamins Intake

Although John is lacking or consumes more than the suggested daily intake of numerous vitamins and minerals, I have chosen to list 3 minerals and 3 vitamins in the table below. According to my assessment, John is consuming enough calcium and potassium but over consuming sodium (SuperTracker, 2017). As sodium accumulates, the body holds onto water to dilute the sodium. This increases the amount of fluid surrounding cells and the volume of blood in the bloodstream. Over time, the extra work and pressure can stiffen blood vessels, leading to high blood pressure, heart attack, and stroke (Schlenker, 2010). John’s intake of vitamin B12 and B6 are adequate but he is not getting enough vitamin A (SuperTracker, 2017). If he becomes deficient he may develop eye and visions problems.

Calculating John’s Daily Caloric Intake for Weight Loss

REE Males: (10 × 115.77 kg) + (6.25 × 177.8 cm) – (5 × 45) + 5

1,157.70 + 184.05 – 225 + 5 = 1,121.75

1,121.75 x 1.200 (Sedentary) = 1346.10

*subtract 500 calories per day for a 1-pound loss per week

Combination of caloric reduction and activity as follows:

30 min walk at 2.5 mph pace for 255 lb. person = 167.72 calories burned

500 – 167.72 = 332.28 actual caloric reduction

New Total Daily Calories: 1346.10 – 332.38 = 1013.82 = 1014 (Schlenker, 2010)

Calculating John’s Macronutrients

I calculated John’s Macronutrients taking into consideration the ADMR (Carbs 45-65% of total calories, Fat 20-35% of total calories, Protein 10-35% of total calories) by using The MacroNutrient Calculator. I chose a moderate daily carb intake because I believe this is a more realistic goal to give John (The MacroNutrient Calculator, 2017). Someone who is consuming as many carbs daily as John will have a harder time sticking to a plan that is low in carbs. I want to set him up for success and baby steps are the key. This plan can be modified later down the road.

Recommended 2 Day Diet Plan

To create John’s meal plan based off his daily macronutrients and caloric intake I used the Eat This Much Meal Plan Generator. This website is a great tool to generate various meal plans. You can create a profile for each individual client, enter their demographic information, goals, macronutrients and daily calories. Once you have input all the required information you can generate various meal plans based off your specific needs. If you don’t like a meal plan then keep hitting the regenerate button for additional options (Much, 2017). I input all of John’s information and chose to create a meal plan that allows him to eat 5 times a day which is what he is accustomed to. The meal plans below hit all macronutrient goals, stay close to caloric requirement and are low in cost. Also, delicious and easy to prep.

Meal Plan Day 1

Meal Plan Day 2

Recommended Dietary and Lifestyle Changes

If John truly wants to make a change for the better he needs to follow the suggested meal plans, exercise, and stay positive. John is currently obese, at risk for various health problems, and obviously unhappy since he is seeking help. If he reduces his weight he will decrease his risk for Type 2 Diabetes and Sleep Apnea. Also, decreasing his sodium consumption will reduce his risk of high blood pressure and Heart Disease (Schlenker, 2010). Exercising will benefit John immensely by controlling his weight, strengthening his bones and muscles, and improving his mood and mental health (7 great reasons why exercise matters, 2017). Most importantly, keeping a positive attitude is a huge stress relief and will give him a peaceful state of mind. It is not easy going from eating whatever you want to a restricted diet. Positive thoughts are empowering. A negative attitude can set processes in motion that makes losing weight difficult, if not impossible (The Power of Positive Thinking, 2017). If John follows these simple but effective steps he will achieve success in his journey to a healthier and happier self.