Krystle Binkowski

ADIME Documentation Case Study: Adult Weight Management

Assessment
Food/Nutrition-Related History
Food/Nutrient Intake:
Energy Intake: 3109 kcal/day
Amount of food: He will have to follow the estimated servings based on the
guideline recommendations
Bioactive substance intake: 2 cans of beer 5 days per week
Micronutrients intakes: unlikely to be low in beta-carotene, vitamin C, folate,
calcium, riboflavin, vitamin B12
Areas of Knowledge: cut back on sweets, unclear if he understands energybalance or about occasional foods
Beliefs/Attitudes:
Conflicts: Really enjoys retirement and spends alot of time with family and
friends
Readiness: Contemplation Phase: wants to change but doesn't know where
to start
Emotion: Worried about health risks but enjoying the life he has
Social Network: support from wife and friends
Physical Activity/Functions:
Changed from moderate to sedentary because of retirement in the last 6
months
Nutrition Education: None
Eating Environment: most consumed with friends and family in social
settings
Anthropometric Measurements
Height/length: 5 ft 9 in
Weight: 198 lbs
Weight change: 26 lb weight gain in 6 months
1 lb/ week
Body Mass Index: BMI is 29.4 kg/m^2, overweight
Nutrition-Focused Physical Findings
Appearance: clothes are too tight
Body Language: open communication
Blood Pressure: 130/85 mmhg
Client History
Age: 65 years old
Gender: Male
P: hypertension (wants to avoid anti-hypertensive medication)
F: type 2 diabetes on his mothers side and cardiovascular disease on his
father's side
Comparative Standards
ENERGY NEEDS (CS-1)

Krystle Binkowski
ADIME Documentation Case Study: Adult Weight Management
Total energy estimated needs: 2330 kcal (9780 KJ)
Method for estimating energy needs: Mifflin-ST Jeor with sedentary activity
(1.4 activity factor)
MACRONUTRIENT
NEEDS (CS-2)
Total protein estimated needs: 85 g/day (rounded up from 83 kg)
Method for estimating needs: 0.8 to 1.0 g protein/kg of adjusted body
WEIGHT AND GROWTH
RECOMMENDATION (CS-5)
Ideal/reference body weight (IBW): Midpoint of BMI body weight range= 163
lb (74 kg)
Recommended body mass index (BMI): 21-27 kg/m2, that is 141 to 182 lb
(64 to 83 kg)
Diagnosis
Problem 1- Excessive Energy Intake
Etiology- Related to: Increased snack and drink consumption while
socializing and a limited knowledge of energy-dense foods and beverages
Signs and Symptoms- As evidenced by: Current average intake is 3109
kcal/day (12449 KJ/day) compared to estimated energy requirements of
approximately 2330 kcal/day (9780KJ/day) with at least 598 kcal/day (2499
KJ/day) from occasional foods and weight gain of 4 lb (~2 kg) per month over
the past six months
Problem 2- Overweight/Obesity
Etiology- Related to: frequent intake of energy-dense foods and reduced
activity since retirement
Signs and Symptoms- As evidenced by: BMI 29.4 kg/m^2
Problem 3- Physical Inactivity
Etiology- Related to: Retirement six months ago and lack of awareness of
the significance of recent changes in activity relative to energy expenditure
Signs and Symptoms- As evidenced by: Less than 30 min of moderate
activity on most days compared to previous moderate activity level before
retirement
Problem 4- Undesirable Food Choices
Etiology- Related to: no previous need to restrict calories, increase in social
activities during retirement
Signs and Symptoms- As evidenced by: Low intake of vegetables, fruits
and dairy and five to seven servings of occasional foods daily, including
energy-dense occasional foods, when compared to the national dietary
guidelines
Problem 5- Not Ready for Diet/Lifestyle Change
Etiology- Related to: Still adjusting to retirement lifestyle

Krystle Binkowski
ADIME Documentation Case Study: Adult Weight Management
Signs and Symptoms- As evidenced by: statement that he is "considering"
making some changes in eating habits
Intervention
Nutrition Prescription/Goal Nutrition Intervention Food and/or
Nutrition Delivery
Nutrition Education
Recommended Modifications: Excessive energy intake and limited knowledge
of energy-dense foods
Substitute other foods for occasional foods
Initially: 1
After: 5
Recommended Modifications: Undesirable food choices and no previous diet
or contact with Dietitian
Reduce occasional foods and decrease meat servings
Initially: 2
After: 6
Other Related: Physical inactivity and lack of awareness
Increase physical activity to up to 60 min. of cumulative moderate
activity daily
Initially: 3
After: 7
Nutrition Counseling
Theoretical Basis/Approach:
Cognitive behavioral theory: Excessive energy intake & increased drinks and
snacks/ physical activity
Set goals for occasional food selection and physical activity
Initially: 4
After: 4
Strategies:
Goal Setting: Excessive energy intake & increased drinks and snacks/
physical activity
If successful in resolving ambivalence, identify specific changes in
physical activity diet choices
Initially: 6
After: 6
Problem Solving: Excessive energy intake & increased drinks and snacks/
physical activity
Identify alternatives to occasional food and beverage choices in social
settings
Initially: 5
After: 8

Krystle Binkowski
ADIME Documentation Case Study: Adult Weight Management
Social Support: Excessive energy intake & increased drinks and snacks/
physical activity
Identify type of social support desired, how to gain support and impact
of changes on family and friends
Initially: 7
After: 9
Coordination of Nutrition Care
Collaboration and Referral to Nutrition Care Transfer:
Referral to other providers: Physical Activity
Exercise Physiologist
Overweight Adults may be subjected to additional body stresses with
exercise. An exercise physiologist will be able to provide Mr. Robertson
with a graded exercise and lifestyle intervention plan
Initially: 8
After: 10
Prescription
2500 kcal (10000 KJ) per day distributed across the food categories
according to national dietary guidelines with only one to two servings of
occasional food per week, reduced serving of evening meal, to match
serving sizes outlined in the guidelines and adding an accumulation of 60
minutes of moderate activity per day (subject to physician approval)
Eliminating the occasional foods that contribute an average of
approximately 600 kcal (2500 KJ) per day will stop weight gain. Sixty
minutes of moderate activity will use about 250 kcal (1000 KJ) per day,
resulting in a loss of lb (~250g) weight per week.
Goal/Plan
Initially to reduce energy intake and/or increase energy expenditure by at
least 500 kcal (2000 KJ) per day in order to prevent further weight gain
Then to reduce energy intake and/or increase energy expenditure by a
further 250 kcal (1000 KJ) per day in order to achieve weight loss of
approximately 2 lb (1kg) a month
Monitoring and Evaluation
Food and Nutrient Intake:
Total Energy Intake:
Indicator for Success: 2500 kcal (10500 KJ) for maintenance
Recommended Time Frame For Measurement: 1 month
Indicator for Success: 2000 kcal (8400 KJ) for weight loss
Recommended Time Frame For Measurement: 2 month
Food Intake Occasional Foods:
Indicator for Success: Four half-size servings per week as per diet
history

Krystle Binkowski
ADIME Documentation Case Study: Adult Weight Management

Recommended Time Frame For Measurement: Next Consultation

Knowledge/beliefs/attitudes:
Increase in knowledge about identifying occasional foods:
Indicator for Success: Able to Answer questions
Recommended Time Frame For Measurement: End of Consultation
Increase in knowledge about consequences and risks of obesity:
Indicator for Success: Able to Answer questions
Recommended Time Frame For Measurement: End of Consultation
Increase in knowledge about benefits and targets for physical activity:
Indicator for Success: Able to Answer questions
Recommended Time Frame For Measurement: End of Consultation
Behavior:
Adherence to established goals that address low-energy soda (soft drink),
meat servings, low-starch vegetables, occasional foods and nuts:
Indicator for Success: Self-rating of about 80% of time
Recommended Time Frame For Measurement: Next consultation
Anthropometrics Measurements:
Weight Change:
Indicator for Success: Maintenance or slight loss
Recommended Time Frame For Measurement: Next Consultation
Body Mass Index:
Indicator for Success: Maintain or decrease
Recommended Time Frame For Measurement: Six Months