Josephine D.

Natalia
BSND4A

CASE STUDY
This in preparation for your virtual counseling,"One on One" with an actual client next week.
Please answer the questions at the end of the Case Study presented. I am also providing
as an attachment, an additional form, the CLIENT HISTORY FORM, which you can use for the
nutritional consult.

CASE STUDY
A.R. is a 25 year old event organizer who is 5’4’’ tall and weighs 107 lbs. At age 14, the client
began to diet because she was slightly overweight and dissatisfied with her body, immediately
assuming a rigid eating pattern. Her avoidance behaviors include lying about food, doing
exhausting physical exercise, and eating less. Currently, activities that occupy her entire day are
her work, thinking about food, and controlling her image and weight by means of clothing,
dieting,
and comparing nutritional labels. She is on a hypocaloric diet, so she is constantly hungry. Last
year, she tried juicing/ detox diets as well as water therapy. Her goal is to reach 104 lbs.
Based on initial assessment, client’s waist circumference = 24 in, hip circumference = 29 in,
body
fat = 16%. She is allergic to seafood and has lactose intolerance. She tends to skip meals
especially breakfast and snacks. Her food preference includes eating only fresh fruits,
vegetables,
and whole grain products. She has no medical conditions but has a family history of diabetes
and
cancer. She is not taking any medications or supplements. She does not smoke or drink
alcohol.
With regard to family dynamics, her parents’ marital relationship is cold. The mother is
pessimistic,
is invasive, and has little ability to negotiate, and her predominant values relate to social image
(comparisons, criticisms).

1. What is the client's Nutritional Status ?

5’4” = 64 inches x 2.54 = 162.56cm or 1.62m
107 lbs / 2.2 = 48.63
BMI = 48.63 / 1.62 m^2 = 18.56
BMI Interpretation: Normal (to lean)

2. Give the TCR using the Krause Method. Give the C P F Distribution.
DBW = (162.56 - 100) - 10% = 62.56 X .10 = 6.256
= 62.56-6.256 = 56.304 or 56 kg
56 x 35 = 1960 kcal
C = 1960 x .65 = 1274 / 4 = 318.5 or 320g
P = 1960 x .15 = 294 / 4 = 73.5 or 75g
F = 1960 x .20 = 392 / 9 = 43.5 or 45g

3. What is your Dietary Prescription for her?

1960 kcal ; 320g CHO; 75g CHON; 45g Fat of Lactose-free diet divided into 3 meals and 2
snacks

4. Create a Meal Plan using the FEL and a One-Day Sample Menu.

FEL
Item Exchanges Carbohydrates Protein Fat Kcal
320g 75g 45g 1960

Veg 5 15 5 - 80

Fruits 5 50 - - 200

Partial Sum = 320-65= 255g

Rice 10

B 6 138 12 - 600

C 4 92 16 - 432

Sugar 5 25 - - 125

Partial Sum = 75-33 = 42

Meat 5

Low fat 2 - 16 2 123

Med fat 3 - 24 18 172

Partial Sum = 45 - 20 = 25

Fat 5 - - 25 225

Total 320g 73g 45g 1957 kcal

Exchanges
Item Breakfast Am Snack Lunch Pm Snack Dinner

Veg 1 1 1 1 1

Fruit 1 1 1 1 1
Rice
B 2B 2B 2B
C 2C 2C

Meat
LF 1LF 1LF
MF 1MF 1MF 1MF

Fat 1 1 1 1 1

Sugar

ONE DAY SAMPLE MENU PLAN

Breakfast Am Snack Lunch Pm Snack Dinner

Veg Bellpepper & Lettuce & Broccoli (½ (Cucumber , White onion ,

Tomato ( ½ Tomato (1/2 cup) Tomato) Green Chilli
cup ) cup)

Fruit 1 pc Apple 1 pc Lemon 1 cup 40g Banana 1 pc Orange

Watermelon

Rice
1 cup Brown 3 pcs Whole 1 cup brown 1 pc Whole 1 cup brown
rice (2B) wheat bread rice (2B) Wheat Pita rice
(2B) bread (2B)

Meat
Egg (1MF) Grilled Pork Beef Brisket Grilled Tofu Sisig (1
Tenderloin (1MF) Chicken cup)
(1L) Breast 35g (1MF)
(1LF)

Fat 1 tsp 1 Olive Oil 1 Olive oil 1 Olive oil 1 tsp Olive oil

Sugar 1 tsp honey 2 tsps Honey 2 tsps Honey

Breakfast Am Snack Lunch Pm Snack Dinner

1 pc Apple w/ Lemonade 1 cup Banana Shake 1 pc Orange

honey Pork Tenderloin Watermelon Healthy Chicken Tofu sisig and 1
Vegetable Whole wheat Beef Broccoli Shawarma cup brown rice
Frittata and 1 Sandwich and 1 cup brown
cup brown rice rice
5. Visualize that you are actually face to face with the client. How will you conduct the nutrition
counseling ?

First of all I will build rapport, make sure that the client is comfortable talking to me. I will
ask her to tell me the background of her diet, try to connect with her by sharing a little story and
little by little incorporate nutrition education. I will tell her the dangers of her dietary pattern such
as skipping meals. If she’s trying to keep it slim , skipping meals wouldn’t be of great help and it
could also cause detriment to her health in the future. Since skipping meals could mean self
deprivation and self inflicted hunger I would explain to her that self deprivation could only lead to
unhealthy relationship with food such as potential binge eating and many more while self
inflicted hunger could cause digestive problem such as bloating that would only make her
tummy feel full and tight and give her a more noticeable tummy it will affect her more since she’s
trying to appear slim. Also , she has a family history of diabetes and cancer . Researchers
found that skipping breakfast once a week is associated with a 6 percent higher risk of
developing type 2 diabetes. To add to that, not eating enough could lead to having a
constant feeling of tiredness, getting ill more often, hair loss, or skin problems that will
give her a heads up since the patient is image conscious. I will also discuss the
negative effects of detoxing and water therapy. That these practices could cause
increased bowel movement and would make her feel nauseous. I will connect her
nutrition counseling in aspects that she’s conscious about like the effects of not eating
enough to her physical appearance. I will explain the benefits of being actually healthy
rather than just appearing slim and fit. I will also encourage her to include physical
activities in her routine and daily self affirmations.