Running head: RISK REDUCTION

Partner/Risk Reduction Jessi Chipman Ferris State University

RISK REDUCTION Abstract Chris is a 23-year-old single male that lives with his fianc and two children. He works as a service manager at Crossroads Chevrolet in Reed City. He spends the majority of his day walking and doing heavy lifting. He exercises for 60-100 minutes every morning before work and has poor nutritional hygiene. He eats a lot of fast food and snacks poorly throughout the day. He completed the

Realage test on June 28th, 2013 and he was 3 years younger than his chronological age. The Realage test assessed his health, feelings, diet, and exercise and suggested areas for improvement in each category. He is willing and ready to begin a nutritional intervention. Through the United States Department of Agriculture (USDA) website Chris and I developed a plan suitable for his lifestyle so he can maintain his active lifestyle as well as improve his overall health status. He is going to follow the USDAs guidelines closely for the next month and report back to determine if this intervention was adequate for him for evaluation.

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Assessment/Analysis/Diagnosis I had my finance Chris complete the Realage test because he is pretty active and healthy. I wanted to give myself a challenge by creating a health plan for him to remain so young and healthy. After he completed the test, results were exactly what I had expected; 3 years younger than what his real age is. Even though he is very healthy by his exercise habits, he still needs a little guidance on his dietary plan so I decided to help him set goals to keep his dietary choices up to par with his exercise habits. He was willing to give the dietary changes a chance because his health is very important to him. Together we came up with realistic and ideal changes that will help him meet his goal that he set and to improve his overall health. He was aware of the changes needed to be made and worked well with an open mind and heart. My fiancs realage results had positive and negative factors which lead to the result of him being 3 years younger than his real age. For his personal health recommendations he was staying on track by watching his blood pressure which is typically 120/80, by protecting his joints while working out and doing heavy lifting, by getting his cholesterol tested, and by avoiding sunburns even though he never applies sunscreen before sun exposure. The Areas under personal health that were making him younger was keeping his aspirin intake to help reduce his risk of cancer, watching his waist size which is a 32 and a BMI of 21.52, and by sticking with his sleep schedule of 7 to 8 hours a night. His personal health recommendations had no negative aspects or areas that were of great concern. Chriss recommendations for his personal feelings had 5 areas that were making him younger and 2 that were making him older. The areas that were making him younger were his sexual habits, staying in touch with his friends by playing softball two nights a week as well as playing basketball, keeping his stress in check, by staying positive while at work and in his personal life, and by maintaining his sense of purpose and feeling good about his accomplishments thus far in life. He was making himself older by not pulling the plug on his stress related to work and finances, and by not easing his

RISK REDUCTION financial worries. He openly admits that he could use help on getting a handle on his stressors in life enabling them to have complete take-over some days while at work and home. This is where Chriss healthy lifestyle begins to get a little thin lined; his diet. For his personal diet recommendations he had 8 areas that were making him older and 2 that were making him younger. The areas that were aging him included not having a healthy morning meal or not eating a breakfast at all, not eating enough grains or again, none at all, not varying his vegetables, eating too much junk food which primarily is his diet, eating entirely too much processed meat which are included in his daily lunch meals, not eating fish, having Vitamin D absent from his diet, and not expanding his diet and remaining picky on all health related foods. He does stay young by eating fruits and nuts. These two items typically substitute meals for him. His frumpy diet habits definitely need a renovation. Chriss personal fitness habits need very little adjustment. He stays very active inside and outside of the gym. He is keeping himself young by keeping up his cardio and running for an hour every morning, by keeping up his steps by walking all day at work, by building muscle strength through lifting weights daily at the gym, by staying moving throughout his day and night, and following a

workout that is best suited for him. He is constantly on the go with sports, our children, work, and other extracurricular activities. He lives by the statement, a body in motion tends to stay in motion. I often envy his energy and dedication to his personal health, feelings, and fitness lifestyles (Realage 2013). In order to develop an actual and realistic plan of change I completed two wellness diagnoses for Chris. These included the following: Readiness for enhanced nutritional knowledge related to lifestyle changes and readiness for enhanced nutrition related to current diet (Ladwig & Ackley 2011). Having these two diagnoses helped Chris and I have a better understanding of what areas needed the most focus and where we wanted to go with this plan. He is more than willing to accept the idea of change and is enthusiastic about implementing and coordinating it into his life (See Appendices A: Figure

RISK REDUCTION 1). He accepts the fact that his diet is poor and needs a renovation so incorporating it into his busy lifestyle may be the biggest challenge he will face. Planning/Intervention In order for Chris and I to come up with a plan, we completed an additional assessment on his daily nutritional intake (See Appendices B: Table 1). This gave us a 24 hour summary of his regular or usual intake. He states he normally does not follow any particular diet and eats whatever sounds appealing to him in any amount. His daily carbohydrate and caloric intake is extremely high for his age

so this is an area needing to be addressed as well. I first asked Chris what would be an ideal diet for him to follow and what barriers would prevent him from following those guidelines. He was concerned with his habit of eating whatever he wants and work. He is very active and busy so fast food is very convenient for him. He also stated that any diet with increased amount of fruits would be sufficient for him. He has a hard time eating vegetables so this may create a substantial barrier. Chris and I went over the USDA dietary guidelines for My Plate and decided that developing a nutritional adjustment though these guidelines were appropriate for him. His caloric intake for his height, weight, and age should be about 2000g. This should also include daily; whole grains -6 oz., vegetables- 2 cups, fruits- 2 cups, dairy- 3 cups, and proteins 5 oz. (United States Department of Agriculture 2011). We created a plan for him based off those specific guidelines stating the following: Watch what goes onto his plate, reducing the amount of carbohydrates and calories he typically intakes by: Making half his plate fruits and vegetables. Switch to skim or 1% milk. Making at least half of his grains whole. Varying his protein food choices.

Cut back on food that are high is solid fats, added sugars, and salts: Choose foods and drinks with little or no added sugars. Look out for salt (sodium) in foods he buys.

RISK REDUCTION Eat fewer foods that are high in solid fats.

Eat the right amount of calories for him according to the USDA standard dietary guidelines Enjoy his food, but eat less. Cook more often at home, so he can be more aware of what is in his food and cut back on fast foods. When eating out, choose lower calorie menu options. Write down what he eats and keep track of how much he eats. If you drink alcoholic beverages, do so sensibly - limit to 2 drinks a day.

Stay physically active by keeping his regular physical activity schedule.

All of these guidelines can be found on a pamphlet created by The United States Department of Agriculture (USDA) so Chris has access to this information whenever it needs to be reviewed (The U.S. Department of Agriculture 2011.). Chris will self-monitor his daily intake by keeping a log of his daily intake. He will analyze his data and determine if the goals he has set are attainable and improving his nutritional intake, overall increasing his health. He will then report back to me within the next month to keep up with his plan or to make adjustments in order to meet his nutritional goals. Evaluation Chris has access to the USDAs website in case he needs any clarification to his dietary guidelines. He has adequate information to keep him from eating his high carbohydrate and calorie diet and the complications that come with a diet high in carbs and calories. He is enthusiastic to have his diet meet his exercise standards. He will report back after the next month to see if his new guidelines are working for him. He has high expectations for quality outcomes because several people support this program including the First Lady and according to the United States Department of Agriculture 2013: The USDA Center for Nutrition Policy and Promotion (CNPP) works to improve the health and well-being of Americans by developing and promoting dietary guidance that links scientific research to the nutrition needs of consumers. The CNPP uses the data collected via 24-hour

RISK REDUCTION recalls of dietary intake in national surveys. The healthy eating index is also used to examine

relationships between diet and health-related outcomes and between diet cost and diet quality, to determine the effectiveness of nutrition intervention programs, and to assess the quality of food assistance packages, menus, and the US food supply. Since there is not enough time for a full evaluation, Chris will keep a log and report his success at a later time. I have had a chance to evaluate the last few weeks of his progress and as long as he continues to avoid fast food his goals should be met. He has been successful thus far. Keep up the good work Chris.

RISK REDUCTION Appendix Appendix A: Figure 1: Willingness to Change Guidelines

Establish a relationship with Chris

Setting the Agenda 1) Getting BMI 2) Get 24-hour food intake 3) Talk about changes in diet and what he is willing to change, if anything

Assess Current Dietary Intake or Dietary Changes Made Ask Chris to assess his diet on a scale of 1-10 by giving a number rating 1= very poor 10= excellent Ask for specific reasoning for numeric rating. i.e., too many snacks Conduct 24 hour food questionnaire for dietary assessment

Interpret Dietary Intake or Changes Calculate BMI and interpret percentile Ask Chris t to interpret perception of his BMI or weight for height percentile Ask Chris to interpret diet from Nutrition Guide Ask Chris how he feels about diet versus recommendations

Determine Readiness to Make Dietary Change 1-3=not ready 4-7=ambivalent 8-10=ready Ask Chris to assess willingness to change on a scale of 1-10 Ask why that number was chosen. Try to get specific reasons.

Develop Plan/Intervention Based on Readiness to Change

Stang, J., & Story, M. (2005). Nutrition screening, assessment and intervention (52). Retrieved on July 28, 2013, from http://www.epi.umn.edu/let/pubs/img/adol_ch4.pdf

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Appendix B: Table 1: Daily Food Intake Record: Nutritional Assessment Total Daily Calories Meal/Snack Breakfast 2715g Total Daily Carbohydrate Grams: Carbohydrates Grams 31g 1g 230g Calories/Comments 440g 29g

Food Item(s)/ Amount(s) Sausage Biscuit from McDonalds Coffee with tsp. cream and 1 Tbsp. sugar

Snack Lunch

cup of peanut M&Ms 2 slices of white bread 2 Tbsp. of Peanut Butter 1 oz. of Potato Chips 2 cups of green grapes

52g 23g 6g 19g 54g

440g 140g 188g 138g 208g

Snack Dinner

No afternoon snack 1 cup of egg noodles cup of parmesan cheese cup butter 1 cup canned green beans 37g 1g 2g 7g 147g 60g 600g 61g

Snack

2 cups of mint chocolate chip ice cream

30g

264g

Stang, J., & Story, M. (2005). Nutrition screening, assessment and intervention (52). Retrieved on July 28, 2013, from http://www.epi.umn.edu/let/pubs/img/adol_ch4.pdf

RISK REDUCTION References Ladwig, G. B., & Ackley, B. J. (2011). Mosby's guide to nursing diagnosis (3rd ed.). Maryland Heights, Mo.: Mosby/Elsevier.

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RealAge: Health Assessments & Tips, Health Information - Sharecare. (n.d.). RealAge health, assessments & tips, health information. Sharecare. Retrieved on July 28, 2013, from http://realage.com Stang, J., & Story, M. (2005). Nutrition screening, assessment and intervention (52). Retrieved on July 28, 2013, from http://www.epi.umn.edu/let/pubs/img/adol_ch4.pdf The U.S. Departments of Agriculture and Health and Human Services (2011). Lets eat for the health of it. USDA. Retrieved on July 28, 2013 from http://www.choosemyplate.gov/foodgroups/downloads/MyPlate/DG2010Brochure.pdf United States Department of Agriculture (2013). Center for nutrition promotion and policy: healthy eating index. USDA. Retrieved on July 28, 2013 from http://www.cnpp.usda.gov/HealthyEatingIndex.htm United States Department of Agriculture (2011). Choose my plate. gov. USDA. Retrieved on July 28, 2013 from http://www.choosemyplate.gov/ Velicer, W. F, Prochaska, J. O., Fava, J. L., Norman, G. J., & Redding, C. A. (1998). Detailed overview of the transtheoretical model. Applications of the transtheoretical model of behavior change. Homeostasis, 38, 216-233.