Nutrition and Lifestyle Management - Essay Example

?Nutrition and Lifestyle Management: A case study Introduction: This is a case of a 55 year old female presenting with symptoms of mostly digestive complaints such as heartburn that occurs twice a week, an occasional abdominal bloating, flatulence, irregular bowel habits, itchiness of the anal part especially during at night along with other symptoms such as dry skin and tiredness plus the fact that she is overweight. All these complaints could be associated with her weight and activities which will be evaluated within the context of this paper for analysis that could in the better end of this study would present this person a solution to these mentioned problems. The person whose nutrition and lifestyle is analysed in this paper is given due confidentiality throughout the length of this paper. Nutrition-wise the client is way over board the ideal weight with a Body Mass Index (BMI) of 35 as calculated from the client’s present height and weight which is in turn inappropriate for the client’s body built. According to the BMI table (Table 1 of appendix), a BMI of 35 belongs to obese category II (WHO). The client exerts a little energy around work spending 8 hours of the office-day in front of the computer and feels too tired later in the day to do anything else. This feeling had been noted even on weekends where she does walking to and from shops as well as movie watching with friends. As of now the client feels and thinks that the client is healthy but otherwise the symptoms are telling a different story. The client’s eating habit is very similar to what most people have due to their busy schedule. It can be seen from the food diary that client digs biscuit on a daily basis and skips eating during one to two most important meals of the day. Family history reveals the presence of cardiovascular disease that took the client’s father at age 65 and mother with known dementia that is still living in a home. Presently the client has no known disease or otherwise not yet revealed and takes no medication of any kind for certain medical conditions though complaints of some symptoms mentioned earlier. With all these information in mind client's nutrition and lifestyle pattern will be evaluated and modified preferentially as age specific and the client’s weight will be controlled and will be able to improve digestion and have essential and significant weight loss not just for a short time achievement but for better health outcome for that matter and to reduce her risks of having medical problems associated with weight gain. Methods of assessment: To analyze the client’s eating and lifestyle behaviour a comparison of the client’s nutritional status with is normal for sex and age was made. This means comparing the client’s actual anthropometric measurement with the normal measurement used as guide for health and nutrition nowadays. The methods used for assessing the client’s nutrition are very basic so that it would not be very difficult to understand considering the client’s age. The basics of food intake, energy expenditure and weight accumulation according to age and gender are some key features that will be made to understand that will help in client’s achieving a sustainable health outcome. Nutritional status defines how well the nutrients in client’s diet meets the body’s physiologic needs which will be done through tools against the actual dietary information (Conley, 2011). According to Vellas et al (2001) there is a high prevalence of malnutrition especially for the elderly that is why nutritional assessment is really important especially in finding appropriate nutritional therapy. Dietary assessment varies per person since individuals have unique needs and concerns so it is important to pattern a design care plan based in the persons dietary assessment findings to answer differences in individuals needs (Minnesota Department of Health, 2012) just like in this case, client’s age is considered as well as activities of daily living together with the risks revealed from familial and actual medical history, menopausal is an example. Anthropometry is the most inexpensive way of assessing the nutritional status of a person. It is the study of the measurement of the human body in terms of the dimensions of bone, muscle, and fat tissue. This will allow analysis of the relationship between obesity and risk of having diseases. For example individuals with large values such as increased body weight are reported to be at increased risks for hypertension, diabetes, cardiovascular disease, gallstones, arthritis, and forms of cancer (Table 3) (National Health and Examination Survey III, 1988). Having a person realize the great degree of chances of acquiring a disease is a great eye opener to motivate a person to change for the benefit of one’s own personal health outcome and to encourage participation in extending one’s life expectancy. This tool is the easiest way since it is very simple, straightforward since facts given are actually from a person’s own, safe and anyone can use this. Weight and height are the ones measured more commonly but for clinical work some other measurements are made (Truswell, 2007). Moreover Anthropometry-based nutritional assessment such as BMI has the advantage of being a universally applicable since it is non-invasive, just the basics of calculating from a person’s weight and height and comparing them with the normative values from thus making it valid to large sample sizes (Chevassus-Agnes, 1999). BMI is an important predictor of mortality among older people such as the client as revealed by some studies thru the analysis of a person’s risk for acquiring diseases (Landi et al., 1999). BMI is a useful measurement of overweight and obesity. It is calculated by getting the weight of a person divided by the person’s height in square (weight/height2). The higher a person’s BMI, the higher the risk for certain diseases (National Heart Lung and Blood Institute, 2012; Brown et al., 2000). BMI has been popular for assessing obesity in adults for many years and now it is being used for children as well to prevent malnutrition and obesity even at a young age and is very important because good eating habits and lifestyle should start young to have better benefits in the future unlike if modifications made after almost a lifelong practice that is already difficult to break but is possible with determination and right attitude (Cole et al. 1995). The client’s BMI is 35 and is categorized as obese category II and researches proves that obesity is associated with the prevalence of diseases especially cardiovascular diseases such as hypertension and dyslipidemia. On the contrary maintaining an ideal age and gender specific body weight entails the lowest case of mortality especially in adults aged 30-59 years old (Tokunaga et al., 1991). In addition to BMI, waist measurement is also very useful for indicating risks in developing diabetes, hypertension and heart diseases because the risk in developing these diseases are greater with people with excess fat in the abdominal area. The risk for metabolic complications increases with a higher waist circumference. In metabolic syndrome, abdominal obesity presents with concurrent features such as insulin resistance, abnormal lipids level, hypertension, and impaired glucose tolerance that amplifies the risk for having cardiovascular disease (American Medical Association, 2003). Thus in the client’s case the risk of developing obesity related diseases is high with a waist circumference of 104 cm imposing a higher risk that needs to be addressed (WHO EUROPE, 2000). Another tool used to evaluate the client’s nutritional status is via a dietary survey such as the food record. A dietary survey is a systematic study of the dietary intake of an individual by basis of the written account of food foods and beverages consumed during a specific time period. The client has a record of the usual foods taken in a form of a diary to list down all the things eaten for a day on a regular basis (Whitney et al., 2010). Food recall probably is the most widely used method of dietary survey but its ease of use has limitations because some people may find it hard to recall everything or the person may not be truthful (Whitney et al., 2010). Evaluating physical activity is one method used to evaluate client’s lifestyle and the modifications to be done in order to meet the nutritional and lifestyle needs. Physical activity is one of the major causes why an individual is overweight. The basic principle of acquiring too much and using too little thus having more reserves explains this. Too much food intake less physical activity thus less energy used and unused energy are stored as fats. Exercise in many forms increases energy output and burns stored fats in the body thus maintaining a good health status. Moderate physical activity is recommended for all adults and requires about much activity such as walking two miles in 30 minutes. The recommended for adults is about 30-60 minutes of moderate activity on a daily basis (Driskell, 2005). Result Interpretation and analysis: From the client’s food diary it can be analyzed to be an unhealthy eating pattern due to skipping of meals particularly breakfast and lunch. Breakfast skipping is highly prevalent in Europe, according to studies about 10% to 30%, this could be a probability why most Europeans are obese. Breakfast eaters generally consumed more daily calories yet were less likely to be overweight, although not all studies associated breakfast skipping with overweight. Evidence suggests that breakfast consumption gives a person ample energy needed to cover the activities per day depending on a person (Rampersaud et al. 2005). A healthful breakfast on a daily basis should be consisting of a variety of foods, especially high-fibre and nutrient-rich whole grains, fruits, and dairy products that seems to be lacking regularly in the client’s daily food routine that makes her less energetic and tired mostly due to lack of proper nutrition from improper eating habit. There should be balanced nutritional intake. The client, being a woman, needs a variety of whole grains, fruits and vegetables, lean proteins and low-fat dairy foods for adequate nutrition. According to studies women should have three servings of whole grains, three servings of low-fat dairy products, 5 to 6 oz. of lean protein, 2 cups of fruit and 2 1/2 cups of vegetables on a daily basis. Also a recommendation of a 2- to 3-ounce serving of meat, chicken or fish, 1 cup of beans counts as 2 oz. of lean protein and 1 cup of cereal is essential (Murphy, 2010). Most of these components lacks in the client’s daily food intake. The client is missing the recommended caloric intake for her age coming from well distribution of carbohydrates, fats and protein. Client takes almost all calories from carbohydrates such as pastries, toasts and biscuits during the whole day from mid morning snack till before bed time spree. The composition of the client’s meal is not well balanced according to the recommended food pyramid intake (table 2). Enough fibre seems to be lacking in the dietary regimen which is needed for good metabolism. The client has a minimal variety of food from limited food types that is why ample nutrition for age is lacking such as fibre and grains which is essential for metabolism and flushing out toxins inside the body. Aside from skipping main meals during the day the major contributory factor to client’s weight gain is the heavy eating only at night where not much energy will be spent compared to day time work. Skipping meals and having inadequate nutrient intake does not give the client enough energy to spend making the client exhausted at the end of the day. Furthermore the food consumption at night only adds up to the pile of stored energy reserves in the form of fats thus gaining more weight. Water is also essential for proper metabolism and hydration and one-half to one litre of water is not sufficient instead at least 2.7 litres of water per day. The client likes coffee and tea and caffeine induces frequent urination which is the more water intake is encouraged. Water is an important mineral that maintains body balance such as heat regulation, transport of vital nutrients within the body and excreting waste products of metabolism (National Academy of Science, 2012). Another factor is the client’s level of activity. The client is a sedentary type due to minimal physical activity-- spending 8 hours a day in front of a computer at work and having a little walk during weekends. According to research, sedentary women require the fewest calories per day, especially overweight sedentary women like in this case. According to study sedentary adult women ages 19 to 25 require about 2,000 calories per day, sedentary women ages 26 to 50 require about 1,800 calories per day and sedentary women ages 51 and older require about 1,600 calories per day to maintain their body weight (Coleman, 2011). The basic of input output explains this idea, if people put more food into their system they should have ample activity to burn all those food they ate to prevent the body from storing unused energy in the form of fats. Therefore people with little activities require lesser energy but from proper food sources. Advice: Proper advice for the client’s inadequate nutritional status is to address the presenting complaints that are due to nutritional and lifestyle issues. First, to address the digestive complaints is to discuss with the client the proper eating pattern and nutritional food choices according to the recommended food intake according to age. The presence of heartburn and other gastrointestinal symptoms is due to the irregular eating pattern such as skipping meals that alters the gastric acid-base balance causing reflux of gastrointestinal juices. Caffeine is also associated with heartburn thus taking in coffee and tea should be taken on a minimum with adequate meal (Chernow et al., 1979). To aid in developing a better bowel movement incorporation of foods high in fibre is advised such as wheat and vegetables together with adequate water intake of a minimum of 2.7 litre per day to help her have better digestive tract motility also as well as to help excrete out body toxins and relieve skin dryness. Physical activity is also a way to help promote better gastrointestinal movement thus advising to walk on an average of 30 minutes per day that can be easily done in the park. For the main problem of obesity diet modification will be made according the recommended standards. Studies say that weight loss diets consisting of 1,000 to 1,200 calories per day can help most women lose weight. It is important before starting on a nutrition and lifestyle modification to assess the willingness of a person to undergo such essential changes. The client is made to realize the risks in health that can be resolved with proper conviction. Helping people in the realization of the consequences of being overweight and offering them solutions that is beneficial always have positive outcome. Starting on a meal plan according to the recommended calorie is a kind of information highly available today. Most importantly seeing a professional nutritionist regularly for a perfect daily meal plan according to age is the most precise recommendation. An example of a meal plan appropriate for the client’s beneficial nutrition modification is a 1500 calorie meal plan (Table 4). Conclusion and reflection By completing this case study brought self assessment and realization of personal nutritional status. With the knowledge brought by the case it points people into the realization that being healthy is a personal choice and conviction. It is may sound complex and strict but staying at the prime of one’s health only needs the realization of the balance of sufficient food intake and routine physical activity that can leap a mile in a person’s health improvement. A better outlook on food as more than just a basic appetite satisfier increased. One of the key learning in this study is the anthropometric measurement taking and the corresponding risks in health it has just such as BMI computation that can lead people into thinking about the great risks in health they are faced if not properly addressed. In practice people should be thought about the significance of such pertinent data for self assessment. With all these beneficial health information in mind proper dissemination to basically every people a person know can help improve the health of many people around the world. 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Available from: [Accessed 26 June 2012] WHO EUROPE (2000) CINDI dietary Guide. World Health Organization Regional Office Europe, Copenhagen, pp. 1-39 APPENDIX Table 1: The International Classification of adult underweight, overweight and obesity according to BMI (WHO, 2004) Classification BMI(kg/m2) Principal cut-off points Additional cut-off points Underweight Read More