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Nutrition Care Process (NCP) Assessment Form

Current Medical Dx: Obesity

PMHx: None

Ht: 68” Wt: 235# UBW: 200# DBW 154# %DBW 152% BMI 35.7
%Wt Loss/Gain 17.5% Over 12 Months Intentional Unintentional No Change
Dietary Intake/Appetite ____100___% No Change Fluid Intake ____2760_____ml
GI Nausea Vomiting Diarrhea Difficulty Heartburn Bloating None
Symptoms Chewing /
Oral Condition Own teeth or dentures Few teeth or lost dentures Edentulous (no teeth)
Assessment wt: 106.8 Estimated needs Kcal 1708- (16-20 kcal/kg) Protein 85.4 (.8 gm/kg)
kg 2136
Fluid 3738 (35 mL/kg)
Pertinent Nutrition Labs (Include Date):
Chol 205 mg/dL Increased, HDL 35 mg/dL Decreased (1/10/2019)

Pertinent Nutrition Related Medications/Supplements:

Men’s Multi Vitamin

Current Diet/Order/Regimen Calorie restricted to 2000 kcals/ day

Physical Appearance/Assessment Appears obese and lethargic

Skin Assessment Intact, Good Turgor Fragile/Tears Stage 1 or 2 Pressure Stage 3 or 4 Pressure
Easily Ulcer/Surgical Wound Ulcer
Nutritional No Risk Low risk Moderate risk High Risk
Comments: No food allergies, busy schedule, not active due to busy work schedule, gradually gaining weight over the
past couple of years, father has HTN and obesity, brother has obesity, eats out 4-5 times per week

Nutrition Diagnosis (PES Statement)

#1Excessive energy intake related to lack of competing values (busy job) as evidenced by 35# weight gain over the past couple
of years, BMI 35.7, working 100 hours per week, poor dietary choices and analysis of 24 hour recall.

#2 Obesity related to excessive energy intake as evidences by BMI 35.7 (obese class II), overconsumption of high-fat and/ or
energy dense food or beverage (eating out 4-5 times a week).

#3 Obesity related to increased psychological/ life stress as evidenced by large amounts of inactivity (busy job), estimated
excessive energy intake, BMI 35.7 (obese class II).

Nutrition Intervention
Nutrition Prescription 2000-2100 kcals/ day
Intervention # 1 Energy modified diet of 2000-2100 kcals/day

#2 Nutrition education on meal preparation, healthy options while out


Patient Goal(s) #1 Patient consumes two lunches and one dinner out per week

#2 Patient consumes 2000-2100 kcal/day at least four times a week

#3 Patient will loss 3 pounds in one month

Nutrition Monitoring and Evaluation

# 1Will monitor for dietary intake by 24 hour recalls and weight.



RD Signature
Lily Feldman

Explanation of Risk:
I checked off that this patient was at a moderate risk because of his 17.5% weight gain
over the past 12 months, which puts him in the obese class II for his BMI. Being obese is a
precursor to other health issues down the road; therefore, if we can begin to monitor this we can
limit the negative health outcomes.

Suggestions from ESHA:

After conducting the ESHA report, there are many suggestions I could make. For starters,
he consumed over 6000 kcals and his food choices were not ideal. My first suggestion would be
to limit the calories consumed to about 2000 kcals. This can be done by only getting one Big Mac
instead of two, then I would suggest gradually getting away from the burger side of the menu to
the salads, then not going to fast food restaurants completely. His sodium levels were also
through the roof and this could be done due to all of the fast foods he consumes. With his obese
state and family history of hypertension, he should watch his sodium levels and stay below 2,300
mg per day. To limit sodium, he can replace French fries with lightly salted chips, fresh fruit or a
side salad.