Patient Name

Gender Age Height Weight Wrist Elbow Frame Composition Waist Female 49 Years 55.7 231 lbs 17.1 cm. 7 cm. Large 1.06 (High risk) 47.75

BMI = 37.7 (Obesity-class II) Goal weight = 208 lbs % IBW = 162% (Overweight) UBW = 220 lbs %UBW = 105% (Recent weight gain) Caloric needs = 1,994 Calories/day Fluid needs = 8 cups min Protein needs = 60 g/day

Patient Name
Gender Age Height Weight Wrist Elbow Female 49 Years 55.7 231 lbs 17.1 cm. 7 cm.

Goal weight= 231x.10 = 23.1lbs 231-23.1 = 208 lbs

IBW = 100 + 5(6) = 130 x .10 = 13 130 + 13 = 143 % IBW = (231/143)x 100 = 162% (overweight = 110%<) UBW = 220 lbs % UBW = (231/220) x 100 = 105% ( >100 = recent weight gain) BMI = (wt (lbs)/in x 703 = 37.6 (Obesity-class II 35-39.9) Body frame = height (cm)/wrist circum. (cm) = 167 cm/17.1 cm = 9.8 = large frame For women, a wrist circumference that is below 10.1 cm represents a large frame Waist circumference = 47.75 in For women, a waist circumference >35 inches signifies a higher risk for DM, dyslipidemia, HTN, CVD Body composition = 46.75/45 = 1.06 in (high risk for DM, dyslipidemia, HTN, CVD) Energy needs = (10 x 105) + (6.25 x 167) (5 x 49) 161 = 1,687.75 Calories/day 1,687.75 x 1.3 (activity level) = 2,194.08 Calories - 250 = 1,994 kcal/day Fluid needs = 1,994 kcal/cc x 1 cc = 1,994 cc/day 1,994 cc/240cc (1 cup) = 8 cups/day ABW = (actual ideal) x .25 + ideal = (231-143) x.25 = 22 + 143 = 165 lbs Protein needs = 165/2.2=75kg x .8 g/kg = 60 g/day

Doing great!
Meeting fruit recommendations Meeting vegetable recommendations Meeting fiber recommendations Consuming recommended protein for your body type

Meeting iron recommendations

Could Improve
Lowering fat consumption
Saturated fat

Lowering cholesterol intake Consuming less calories

Controlling portion sizes Making healthier choices

Decreasing sodium intake

Areas to work on:

Decreasing Cholesterol & saturated fat

Decreasing calorie consumption

Decreasing sodium consumption

Improving acid reflux

Excess intake of unhealthy fats

Weight gain

Heart burn and acid reflux

High cholesterol
Higher risk for: type 2 diabetes coronary heart disease stroke metabolic syndrome certain cancers sleep apnea osteoarthritis Gallbladder disease fatty liver disease

Heart Disease

Understanding the Nutrition Facts in a label: FAT Always check how

many servings are in each container, the amounts on the label are per serving, not per container Total fat, Saturated fat, Trans fat and Cholesterol

Terms: Fat-free Less than 1/2 gram fat per serving Low-fat 3 grams fat or less per serving Reduced-fat At least 25% less fat when compared with a similar food Cholesterol-free Less than 2 milligrams cholesterol per serving and 2 grams or less saturated fat per serving. Low-Cholesterol 20 milligrams or less cholesterol per serving and 2 grams or less saturated fat per serving
Adapted from: http://www.fda.gov/Food/ResourcesForYou/Consumers/NFLPM/ucm274593.htm

Choose unsaturated fats over saturated fats

Saturated fats:
Solid at room temperature

Unsaturated fats:
Liquid at room temperature

Disadvantages
Increases LDL levels Raises Blood Cholesterol Increases risk for Coronary Heart Disease

Health Benefits
Anti-inflammatory effects Decreases risk for cardiovascular disease Decreases LDL levels Decreases plaque growth in arteries

Sources: Butter Coconut oil Whole Milk products

Half & half Chocolate Ice cream Egg yolks

Sources: Fish oils Shellfish Leafy Vegetables Some Vegetable oils: Soy Canola Linseed Rapeseed Flaxseed

Cheese Most Animal fats Full fat Dressing Fried foods

Decrease Saturated Fats & Cholesterol

Switch to low fat or fat free ice cream Use low fat or fat free dressings Make healthier snack options Avoid fast foods Consume lean proteins Fish Skinless poultry breast Consume soluble fiber Oats Barley fruits and vegetables Dried peas and beans Watch your portions
Ice cream Dressings sauces

Substitute entire eggs for egg whites or egg beaters

Make healthier choices at the grocery store- Lower your fat consumption
Instead of: Jimmy Dean Heat N Serve Sausage Patties- Regular
Fat (g) Saturated Fat (g) 6.75 Cholesterol (mg) 60

19.5

Try this! Oscar Mayer Turkey Bacon

Fat (g) Saturated Fat (g) 3 Cholesterol (mg) 45

Or this! Jimmy Dean Original Links

Fat (g) Saturated Fat (g) 4.5 Cholesterol (mg) 35

13

Youll save 10.5g of total fat , 3.75g of saturated fat, and 15 mg of cholesterol!

Youll save 6.5g of total fat , 2.25g of saturated fat, and 25 mg of cholesterol!

Use low-fat or fat-free creamers to lower your fat intake!

6g of fat, 4 g saturated fat, and 30mg of cholesterol less per serving of coffee!

3g of fat, 2g saturated fat, and 20mg of cholesterol less per serving of coffee!

Make healthier choices at the grocery store- Lower your fat consumption
Instead of: Breyers Chocolate Ice Cream
Fat (g) Saturated Fat (g) 4.5 Cholesterol (mg) 20

Try this! Breyers the fat Creamy Chocolate

Fat (g) 3 Saturated Fat (g) 2 Cholesterol (mg) 10

Or this! Skinny Cow Chocolate Fudge Brownie

Fat (g) 2 Saturated Fat (g) 1 Cholesterol (mg) 5

Youll save 4g of total fat , 2.5g of saturated fat, and 10 mg of cholesterol!

Youll save 5g of total fat , 3.5g of saturated fat, and 15 mg of cholesterol!

Make healthier choices when eating out- Lower your fat consumption

Instead of: Chicken Nuggets (15 piece)

Fat (g) Saturated Fat (g) 10 Cholesterol (mg) 100

Instead of: Crispy Chicken Salad

Fat (g) Saturated Fat (g) 10 Cholesterol (mg) 70

42.5

23

Try this! Ultimate Chicken Grill

Fat (g) 10 Saturated Fat (g) 3.5 Cholesterol (mg) 100

Try this! Roast Turkey Salad

Fat (g) 13 Saturated Fat (g) 7 Cholesterol (mg) 60

Youll save 32.5g of total fat and 6.5g of saturated fat!

Youll save 10g of total fat , 3g of saturated fat, and 10 mg o cholesterol!

Excess intake of calories

Energy Imbalance

Weight gain

Diabetes Heart Disease Some cancers Breathing problems Sleeping problems Arthritis

Understanding the Nutrition Facts in a label: CALORIES Always check

how many servings are in each container, the amounts on the label are per serving, not per container Calories
General Guide to Calories: 40 Calories is low 100 Calories is moderate 400 Calories or more is high Terms: Low-calorie 40 calories or less per serving Reduced-calorie At least 25% fewer calories per serving when compared with a similar food Light, Lite One-third fewer calories or 50% less fat per serving; if more than half the calories are from fat, fat content must be reduced by 50% or more
Adapted from: http://www.fda.gov/Food/ResourcesForYou/Consumers/NFLPM/ucm274593.htm

Control portions at home

Consume the amount of food that is indicated as one serving on the food label Focus on eating and avoid doing other activities at the same time Savor your food Chew thoroughly Eat slow- this will give your brain time to get the message when your stomach is full Wait 10 minutes after eating before deciding you are still hungry Use smaller dishes, bowls, and glasses If still hungry, take seconds of vegetables and salads without dressings to fill you up When cooking in large batches, freeze leftovers in single serving amounts Try to eat meals at regular times Buy low-calorie snacks in single-serving prepackaged portions to snack on when hungry When buying larger bags or boxes of snacks, divide the items into single-serve packages right away Use measuring cups and spoons to help you control portion sizes
(Adapted from: http://win.niddk.nih.gov/publications/just_enough.htm)

Control portions when eating out

Check the menu for terms and icons indicating healthier items, such as low-fat or low-calorie dishes Share your meal, order a half-portion, or order an appetizer as a main meal After eating, put down your fork and focus on enjoying the setting, it may take 15 minutes or longer for your brain to get the signal from your stomach that you are full Avoid larger, super-sized portions Order water with a slice of lemon to go with your meal Say no to the bread basket before the meal Order a salad with fat-free dressing as an appetizer
(Adapted from: http://win.niddk.nih.gov/publications/just_enough.htm)

Healthier eating while on the road

Pack a small cooler with healthy snacks
fresh fruit sliced raw vegetables of mixed nuts and dried fruit

Take a few bottles of water Choose restaurants that offer salads, grilled and steamed entrees, and vegetables When choosing a higher-fat option like fries or pizza, order the smallest size

(Adapted from: http://win.niddk.nih.gov/publications/just_enough.htm)

Dealing with emotional eating

Instead of overeating when I am bored, I will _____________________________ __
Instead of overeating when I am anxious, I will _____________________________ __ Instead of overeating when I am tired I will _____________________________ __ Instead of overeating when I am stressed I will _____________________________

Avoid energy dense foods

Energy density (opposite of nutrient density) Increases with added fat and sugar Decreases with water and fiber
Example:
Both meals are 500 calories, but you more food when choosing nutrient dense instead of energy dense foods

(Adapted from http://preventcancer.aicr.org/site/News2?page=NewsArticle&id=19233)

Decreasing total calorie consumption

Avoid adding sugar to coffee Add fat free creamer to your coffee Use low fat or fat free dressings Reduce daily serving of nuts Consume low fat or fat free ice cream Avoid processed foods Avoid fried foods Cut down portion sizes

Make healthier choices at the grocery store

Instead of: Jimmy Dean Heat N Serve Sausage Patties- Regular
Calories

255 for 3 patties

Try this! Oscar Mayer Turkey Bacon

Calories 105 for 3 strips

Or this! Jimmy Dean Original Links

Calories 130 for 3 links

Youll save 150 calories!

Youll save 125 calories!

Make healthier choices at the grocery store

Instead of: Breyers Chocolate Ice Cream

Calories

280 for 1 cup

Try this! Breyers the fat Creamy Chocolate

Calories 220 for 1 cup

Or this! Skinny Cow Chocolate Fudge Brownie

Calories 150 for 1 cup

Youll save 60 calories!

Youll save 130 calories!

Use low-fat or fat-free creamers to lower your calories!

At 40 calories per cup, save 160 calories a day!

At 50 calories per cup, save 120 calories a day!

Make healthier choices when eating out

Instead of: Chicken Nuggets (15 piece)
Calories

Instead of: Crispy Chicken Salad

Calories

675

420

Try this! Ultimate Chicken Grill

Calories

Try this! Roast Turkey Salad

Calories

400

230

Youll save 275 calories!

Youll save 90 calories!

(http://www.wendys.com/food/Nutrition.jsp)

(http://www.arbys.com/food/nutrition-info.pdf)

Healthy Snack Choices

Toasted whole grain bread with jam English muffin topped with tomato sauce and low-fat shredded cheese Baked tortilla chips and salsa Rice cakes cup of instant oatmeal Dried fruit Piece of fresh fruit- apple Handful of unsalted nuts cup of fat free ice cream low-fat bran muffin Raw vegetables dipped in fat-free ranch dressing 100% fruit juice popsicle Plain popcorn Fat-free or low-fat yogurt Tomato slices and low-fat cheese Granola bar Low-fat cottage cheese mixed with fresh fruit Write down 3 snack choices that would be best for you at these two times.
1.___________________________________________________

2.___________________________________________________

3.___________________________________________________

High sodium intake

Problems with fluid balance

Swelling or edema

High blood pressure

Heart Disease

Understanding the SODIUM nutrition facts in a label

Always check how many servings are in each container, the amounts on the label are per serving, not per container

Sodium

Terms: Sodium-free/ Salt-free Less than 5 milligrams sodium per serving Low Sodium 140 mg of sodium or less per serving

Adapted from: http://www.fda.gov/Food/ResourcesForYou/Consumers/NFLPM/ucm274593.htm

Decrease Sodium Consumption

Decrease fast food consumption Avoid processed foods Fill up on veggies and fruits- they are naturally low in sodium Choose fresh beef, pork, poultry, and seafood, as opposed to prepackaged options with added salt Purchase unsalted nuts and seeds Cut back on salt little by little to adjust your taste buds10 tips to help you cut back Keep salt off the kitchen counter and the dinner table Use spices, herbs, garlic, vinegar, or lemon juice to season foods instead of salt Choose low sodium, reduced sodium, or no salt added options at the grocery store Pay attention to condiments that are high in sodium

Make healthier choices at the grocery storeLower your sodium

Instead of: Jimmy Dean Heat N Serve Sausage Patties- Regular
Sodium 840 for 3 patties

Try this! Oscar Mayer Turkey Bacon

Sodium 540 for 3 strips

Or this! Jimmy Dean Original Links

Sodium 380 for 3 links

Youll save 300 mg!

Youll save 460 mg!

Make healthier choices at the grocery store

Instead of: OnCor Salsbury Steak Patties

Sodium 2,070 for 3 patties

Try this! Applegate Organic Beef Burger

Sodium 85 for 1 patty

Or this! MorningStar Farms Chipotle Black Bean Burger

Sodium 700 for 1 patty

Youll save 1,985 mg!

Youll save 1,370 calories!

Make healthier choices when eating out

Instead of: Chicken Nuggets (15 piece)
Sodium (mg) 1,400

Instead of: Crispy Chicken Salad

Sodium (mg) 1,020

Try this! Ultimate Chicken Grill

Sodium (mg) 880

Try this! Roast Turkey Salad

Sodium (mg)

780

Youll save 510 mg of sodium!

Youll save 240 mg of sodium!

Chocolate Hiatal hernia Caffeine

Fatty foods
Decrease pressure of the lower esophageal sphincter

Protrusion of part of the stomach through the diaphragm into the space normally occupied by the esophagus, heart, and lungs

Acid Reflux

Tips for preventing heartburn

Eat smaller, more frequent meals Dont lie down for about three hours after you eat Elevate your head a few inches while you sleep Maintain a reasonable weight Limit your intake of fatty foods Limit your intake of caffeine
Gradually decrease by one cup per day Try mixing half decaf coffee with half regular coffee Drink caffeine-free coke

Relax Dont wear belts or clothes that are tight fitting around the waist Keep a heartburn record

Heartburn record

(http://heartburn.about.com/library/np_bwheartburnrecord.htm)

Goals:
1. ____________________________________________________ ____

2. ____________________________________________________ ____

Signature Date

___________________________

_______________

My Contract
Name: Date: I would like to improve my diet in the following areas: I will accomplish this by: Client Signature: Counselor signature: