Dietary Action Plan and Requirements - Assignment Example

Case Study Analysis and Action Plan Introduction In this assignment, a case study analysis will be presented, and the client's need for dietary adjustments will be done according to an action plan drawn based on her current dietary habits, energy requirements, and need of losing excess weight. Scenario Susan is a 28-year-old female whose weight has been increasing steadily. Her anthropometric measurements are 1.6 m height and a weight of 79 kg. Despite slimming programmes, she has not been able to maintain weight in the requisite range in the recent years. She has been emotionally unstable recently due to loss of a close family member and due to a long-term relationship coming to an end. Moreover, there is evidence that she has at least situational depression, if not endogenous depression (Levy, Dixon, and Stern, 1989). Her support networks are poor, and she prefers a lonely life, and thus it can be suspected that she is isolated due to her depression (Wiederman and Pryor, 2000). Comparison of Diet with UK Dietary Reference Values As per UK Dietary Reference Values (DRV. British Nutrition Foundation, 2004), Susan belongs to the adult age group, and hence her energy requirements are lower, so are the requirements of energy will be lower, although they vary according to age, gender, and activity level. With the data provided, Susan's BMI would be 30, which as per references is class I obesity (Buttriss, 2000). Taking the ideal BMI to be 20 to 24.9, for Susan, it would be ideal to keep a target of 22 as the BMI, and to achieve that she will have to bring her weight back to 56 kg. This means she will have to lose about 23 kg of weight. She is a secretary by profession, hence her lifestyle may be considered as sedentary. Diet analysis of Susan indicates that she has consumed 2765 Kcal on an average per day (Swan, 2004). This comes from on an average of 672 g of carbohydrate and related food consumed including sugar and starch. According to DRV, this itself is higher since this should be (50 + 10) % to (47 + 11)% maximum. Although the average British intake is higher, since Susan is overweight she needs to reduce the energy intake by about 1000 kcal a day so over a period of 23 weeks, she will achieve the target weight (Ruxton et al., 1996). Since there is a program for physical activity, an exercise programme comprising of brisk walking and running at a speed of 10 minutes a mile would cause a total loss of 375 kcal per day (Swan, 2004). Having this allowance based on DRV, her energy requirement may be adjusted to omission of fatty food totally and carbohydrate restriction to 200 g (Millward, 2004). Moreover, her protein consumption is within normal limits (Millward, 2004). The values must be adjusted at least roughly, since the dietary reference data cannot provide the accurate amount available from the food or different food elements (DRV, 2004). Bulimia Nervosa Subjects suffering from BN are strongly preoccupied with their weight and afraid of growing fat. BN patients surrender to frequent episodes of binge eating (Boskind-White and White, 1983). This also involves a sense of lack of control over eating during episodes (Keel et al., 2007). Binge Eating Given the data, Susan has indeed an episode of binge eating on the weekend; however, other history is not available (Brownell and Fairburn (eds) 1995). To avoid overdiagnosis, a strict adherence to the DSM-IV criteria mentioned is required (American Psychiatric Association, 1990). An additional inspection may therefore be necessary (American Psychiatric Association, 1990) (Murray, 2003). Since in case of Susan the psychological background supports this diagnosis, entry into the checklist supports the diagnosis, and she should be referred to a suitable healthcare professional (Andersen, 1985). Anorexia Nervosa Anorexia nervosa is described in the ICD 10 Classification of Mental and Behavioural Disorders as deliberate weight loss, induced and/or sustained by the patient' (WHO, 1992). This feature of classification and the emergence of bulimia as a distinct entity, long after anorexia was described, means that the literature on anorexia is often really about both anorexia and bulimia. Anorexia is perceived by the analysts to be a response to a longing to feed greedily. The general literature on eating disorders often suggests that adopting a psychoanalytic stance does not help, especially when the patient is an anorexic at low weight. This may be felt to be especially true at assessment, when the therapist is under some strain and the habitual approach seems to meet with resistance (Boris, 1984). Analysis Obviously, her diet is disproportionate to her requirement, and the excess calorie in her diet is contributing to her weight gain. From the history it is apparent that she is binge eating, and given her psychological history, it may be a case of bulimia nervosa (Schlesier-Carter et al., 1989). Since she is ready for a change, a dietary analysis would be needed to examine the imbalance between her current dietary pattern and the requirement for her age, profession, and stature. More importantly, if she is going to an exercise regimen, it would be needed to advise her how much weight she must reduce (Grilo, Masheb, and Berman, 2001). This can be done through the reduction of caloric requirement, and the new dietary advice must contain the maximum permissible calories without affecting the energy requirement. Since bulimia is the suspected cause, there must be provision for handling these issues through appropriate psychotherapeutic interventions (Stice and Fairburn, 2003). Checklist For Susan's management, the analysis of her problems can be done in the format of the following checklist. Serial Number Entry Description if Any 1 Analysis of case history Detailed history taking and analysis of the factors 2 Dietary Analysis Analysis of the dietary history and comparison with UK dietary reference values 3 Assessment of Psychiatric History Referral to a psychiatrist and establish a diagnosis 4 Anorexia nervosa Unlikely from the history 5 Bulimia nervosa Likely, but not all the features present 6 Binge eating Possible from the weekend history 7 Determination of baseline physical activity Action Plan 1. Refer to a psychiatrist to establish diagnosis. 2. Establish dietary pattern. 3. Provide exercise regimen. 4. Adjust diet. Refer to a psychiatrist to establish diagnosis Susan may have binge eating. Eating more than necessary is not included among psychiatric classification of diseases. Bulimia nervosa is generally regarded in psychology and psychiatry as one of the main eating disorders. Eating disorders are a relatively recent 'syndrome' (Phillips et al., 2003, 261-279). Only in the 1992 version of the International Classification of Diseases, the ICD-10, are eating disorders reported as an articulated and well-defined syndrome (ICD, 1992). As the history suggests she may be bulimic (Fairburn et al., 2000, 659-665). Given this background, the best course of action for bulimia is to first establish the diagnosis, which a psychiatrist would be quickly able to establish. Establish Dietary Pattern The patient will be asked to complete a 5-day food diary in which she would record information on her food and drink intake over a period of 5 day including brand names of the food products she had consumed. She would also record the food preparation methods and recipes used. She will be asked to record the amounts eaten in household measures with preferably black and white food photographs provided to help estimation of portion size (Nicklas et al., 2001, 599-608). Food intake from the food diary will be entered and coded using a specially designed data entry programme. In-house computer analysis programme would be used to calculate energy intake and nutrient intakes, and their mean would be determined. The discrepancy will be analysed to know how much the patient is overeating (Newby et al., 2003, 1417-1425). Provide Exercise Regimen Therefore, along with dietary restriction, physical exercise must be added to the action plan, so the activity involved in exercise may increase body's basal metabolic rate (Varady et al., 2006, 1302-1307). Exercise should begin at mild intensity and for a short period of time and then gradually increase to higher intensity and a longer period of time (Sykes, Choo, and Cotterrell, 2004, 24-28). Adjust Diet The patient must be instructed to eat fruits and vegetables to prevent any increase in free radicals caused by exercise. Table 1 - Comparisons of Susan's nutrient intake to Dietary Reference Values Meal Plan Based on the discussion above, the following meal plan has been prepared that reduces the carbohydrate content of the diet, maintains the protein content, limits the fat content, and adds fruits to the diet. From her dietary record, the excess carbohydrates account for 1950 kcal for her, and adjusting to 200 g of carbohydrate would contribute to 980 kcal per day. Thus with exercise, she will be able to lose 970 Kcal from restriction of carbohydrate and an additional 375 Kcal from exercise. Thus given her age restriction of fatty food would not be necessary, and she can continue the other parameters of her diet. With this she will lose 970 + 375 Kcal = 1340 Kcal per day, and in this way, she will be able to achieve the target weight of 56 kg in 3 weeks' time (DRV, 2004). As per DRV and RNI, her sugar content in the diet should be within 10% of the food energy, alcohol must be maximally 5% of the total food energy, and NSP must be 18 g total in the daily diet. On an average, with her current diet, she is getting less iron, enough calcium, and less fibre. These must be provided in the diet Meal Plan Breakfast Item Amount Coffee-w/caffeine 12 Ounces Bagel-plain, Lenders Bake Shop 1 each Peanut butter-creamy 2 tbsp Cream, fluid, half and half 1 tbsp AM Snack Apple-medium with peel 1 each Lunch Chicken breast/white meat 3 ounces Coca cola- diet without caffeine 12 ounces Croutons-plain 0.25 cup Salad Garden with tomato and onion 1 Large Thousand island reduced calorie Kraft 4 tbsp PM Snack Apple medium with peel 1 each Dinner Chicken breast/white meat 3 ounces Pasta, corn cooked 1 cup Salad small, Garden with tomato and onion 1 small Thousand Island reduced Calorie. Kraft 2 tbsp Grand Total 1343.95 Kcal Reference List American Psychiatric Association (1990). Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. Washington, DC: American Psychiatric Association. Andersen, A.E. (1985). Practical Comprehensive Treatment of Anorexia Nervosa and Bulimia. Baltimore: Johns Hopkins University Press. Boris, H. (1984) 'The problem of anorexia nervosa', International Journal of Psycho-Analysis. 65: 315-22. Boskind-White, M. and White, W.C. (1983). Bulimarexia: The Binge-Purge Cycle. New York/London: W.W. Norton Brownell, K.D. and Fairburn, C.G. (eds) (1995). Eating Disorders and Obesity: A Comprehensive Handbook. New York: Guilford Press. Buttriss, J., (2000). Nutrient requirements and optimisation fo intakes. Br. Med. Bull.; 56: 18 - 33. DRV. British Nutrition Foundation (2004). Nutrient requirements and recommendations Downloaded from http://www.nutrition.org.uk/home.aspsiteId=43§ionId=414&parentSection=320&which=1 on March 9, 2009 Fairburn, CG., Cooper, Z., Doll, HA., Norman, P., and O'Connor, M., (2000). The Natural Course of Bulimia Nervosa and Binge Eating Disorder in Young Women. Arch Gen Psychiatry; 57: 659 - 665. Grilo, CM., Masheb, RM., and Berman, RM., (2001). Subtyping women with bulimia nervosa along dietary and negative affect dimensions: a replication in a treatment-seeking sample. Eat Weight Disord; 6(1): 53-8. Keel, PK., Wolfe, BE., Liddle, RA., De Young, KP., and Jimerson, DC., (2007). Clinical Features and Physiological Response to a Test Meal in Purging Disorder and Bulimia Nervosa. Arch Gen Psychiatry; 64: 1058 - 1066. Levy, AB, Dixon, KN., and Stern, SL., (1989). How are depression and bulimia related Am J Psychiatry; 146: 162 - 169. Millward, DJ., (2004). Macronutrient Intakes as Determinants of Dietary Protein and Amino Acid Adequacy. 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Schlesier-Carter, B., Hamilton, SA., O'Neil, PM., Lydiard, RB., and Malcolm, R., (1989). Depression and bulimia: the link between depression and bulimic cognitions. J Abnorm Psychol; 98(3): 322-5. Stice, E. and Fairburn, CG., (2003). Dietary and dietary-depressive subtypes of bulimia nervosa show differential symptom presentation, social impairment, comorbidity, and course of illness. J Consult Clin Psychol; 71(6): 1090-4. Swan, G., (2004). Findings from the latest National Diet and Nutrition Survey. Proc Nutr Soc; 63(4): 505-12. Sykes, K., Choo, LL., and Cotterrell, M., (2004). Accumulating aerobic exercise for effective weight control. The Journal of the Royal Society for the Promotion of Health; 124: 24 - 28 Varady, KA., Lamarche, B., Santosa, S., Demonty, I., Charest, A., and Jones, PJ., (2006). Effect of weight loss resulting from a combined low-fat diet/exercise regimen on low-density lipoprotein particle size and distribution in obese women. Metabolism; 55(10): 1302-7 Wiederman, MW. and Pryor, TL., (2000). Body dissatisfaction, bulimia, and depression among women: the mediating role of drive for thinness. Int J Eat Disord; 27(1): 90-5. World Health Organisation (1992) The ICD-10 Classification of Mental and Behavioural Disorders. Geneva: WHO. Appendix Read More