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Case Study 1: Overeating Healthy FoodsNameK.C.Age28SexfemaleHeight5’4”Weight162BMI28BMI category (NIH Guidelines)overweightWaist Circumference37”Notes:K.C. was presented to a registered dietitian (RD) with an interest in weight loss. Her medical history was excellent, however her last annual check-up revealed a slight elevation in triglyceride levels. K.C. was always active and never had to worry about her weight. She is an avid exerciser with a weekly routine of both cardiovascular and weight training for 45 minutes to 1 hour at least 5 times per week. She runs 5 and 10 k races for “fun” and walks everywhere as she does not own a car. She recently started dating a man who enjoys running with her, but he also enjoys taking K.C. out to trendy, fancy restaurants. Upon nutrition assessment, K.C. proclaimed herself a “health nut” and verbally listed the types of foods she eats on a daily basis. Her regular fare consisted of fruits, high fiber cereal, granola bars, yogurt, salads with oil & vinegar dressing, whole wheat grains, chicken, shrimp, tuna fish, tofu and reduced-fat cookies. She turned in a 7-day food log. When asked what her weight loss goal was the patient stated a lofty goal of 25 lb within 2 months as she wanted to “look good” for her 10-year high school reunion.Let’s take a look at a typical day. K.C. Food Log WednesdayCalories In (calculated by the RD)Breakfast6:00 AM 1 whole wheat bagel with peanut butter (2 T)8 oz. fruit-flavored yogurt8 oz. orange juice8 oz. water320 + 210 = 530250110Lunch1: 30 PMPanera tuna salad sandwich on honey wheat , 16 oz. water700 (+ 43 grams of fat!!)Snack4:30 PM1 cup trail mix ( ½ c. almonds + ½ c. raisins) 16 oz. water 420 + 260 = 680Dinner(at home)8:30 pm2 cups brown rice, 3 oz. roasted chicken breast (w/out skin), 1 c. steamed broccoli with a 1 Tbs. olive oil and fresh garlic 8 oz water440 + 140 + 50 + 120 = 750 Snack10:30 pm1 Kashi Go-Lean bar8 oz. water290 Total Calories In = 3310ActivitiesCalories Out (energy expenditure)Walk – 2 miles to/from work (~20 minutes)35 minutes on elliptical machine at high intensity 20 minutes of stretching 280 calories burned350 calories burned75 caloriesTotal Calories Out = 705Total Calories In = 3310 – 705 = 2605 1. Her diet sounded healthy, but what did her food logs reveal? 2. Nutrition Assessment: Upon looking at the composition of K.C.’s diet, what does it reveal?3. Nutrition Recommendations: What are your recommendations for KC?4. Food Log Makeover (according to the new Dietary Guidelines for Americans (taking into account the same activity level)WednesdayCalories Breakfast6:00 AM Snack9:00 amlunch12:30 PM Snack4:00 pmDinner8:00 pm Total Calories In = Case Study 2: Consistent Meal SkipperNotes:F.S. presented to a registered dietitian (RD) complaining of lack of energy and fatigue. His medical history revealed Class II obesity, high cholesterol, high blood pressure, and slightly impaired glucose tolerance (pre-diabetes). F.S. used to be very active in his younger years, but became sedentary with his office job. The only activity he gets is walking to and from the train station daily (~ 2 blocks). His wife is a “great” cook and enjoys making elaborate dinners every night.Upon nutrition assessment, F.S. went through a typical day in no time flat as he claimed “not to eat a lot”. He was baffled by his weight gain over the years as the majority of his day he didn’t eat. He only eats breakfast on the weekends (or we should say “brunch”); lunch is a quick sandwich or soup, chips and diet soda. Although not a chocolate lover, he does have a 3:00 pm snack of a “handful” of M&M’s because they are on his secretary’s desk. By dinner he is extremely hungry. From the moment he walks in the door at 6:00 pm, the first thing he does is open the refrigerator door and peeks in for something to pop out at him. He typically reaches for a slice or two of cheese and/or salami. Then he opens a beer to “relax” him for the evening. Dinner, which is usually meat, potatoes or rice, and vegetables with “some sort of sauce”, is usually ready by 7:00 pm. He always has seconds.Name F. S.Age 44Sex maleHeight 5’10”Weight 220BMI 35BMI category (NIH Guidelines) obeseWaist Circumference 44”Let’s take a look at a typical day.F.S. Food Log MondayCalories In (calculated by the RD)Breakfast6:00 AM Nothing – just a large glass of water0Lunch12: 30 PMAu bon pain vegetarian chili in a bread bowl 1 can diet soda770 caloriesSnack3:00 PM6:00 PM1/4 cup plain M&M candies2 slices mozzarella cheese, 2 slices of hard salami, 1 regular beer210 calories (+ 9 grams of fat!)180 + 110 (+ 10 grams of fat!) + 140 calories = 430Dinner(at home)7:00 pm2 slices of Meatloaf (6 oz.) , 3⁄4 c. mashed potatoes w/ pat of butter 1 c. broccoli w/ 1 oz. cheddar cheese sauce 8 oz water570 + 200 + 35 + 50 + 110 = 965Snack10:30 pm1 cup vanilla ice cream 8 oz. water260 calories (+ 14 grams of fat!) Total Calories In = 2,633ActivitiesCalories Out (energy expenditure)Walk – 1/4 mile to/from train 100 calories burnedTotal Calories Out = 100Total Calories In = 2,633 – 100 = 2,5331. What did his food logs reveal? 2. Nutrition Assessment: Upon looking at the composition of his diet, what does it reveal?3. Nutrition Recommendations: What are your recommendations?4. Food Log Makeover (according to the new Dietary Guidelines for Americans (taking into account the same activity level)MondayCalories In (calculated by the RD)BreakfastSnack lunch SnackDinner Total Calories In = Case Study 3: Eating Out- High Fat1. Notes:C.C. presented to a registered dietitian (RD) complaining of recent weight gain, especially “around the middle.” Her medical history revealed Class I obesity, borderline high blood pressure, elevated fasting blood sugar and recently diagnosed polycystic ovarian syndrome (PCOS). C.C. was married last year and was interested in starting a family soon. Her doctor recommended that she see an RD because nutrition plays a big role in fertility (especially with PCOS).Upon nutrition assessment, C.C. mentioned that she used to like vegetables and fruit, but has not had “a taste” for them in awhile. Over the last year – after her wedding, she and her husband have been too busy to cook and have fallen into the habit of dining out often. Although, she was quick to qualify with where they eat – “not fast food places or anything like that.” According to C.C. she was not snacker, and only ate an occasional cookie in the afternoon. Her typical dinner always included high fat, fried foods. She and her husband would frequently order fat-laden appetizers or tack on an order of fries – to share.With no motivation to work out, C.C. was depressed about her weight, but felt helpless to control it.Name C.C.Age 28 Sex femaleHeight 5’4”Weight 198BMI 34BMI category (NIH Guidelines) Obese (Class I)Waist Circumference 37”Let’s take a look at a typical day.C. C’s Food LogMondayCalories In (calculated by the RD)Breakfast8:00 AM1 muffin (4 oz) 1 grande latte (with whole milk)320 (12 grams fat) 265 (14 grams fat)Snack 00Lunch12:30 PM 1 cup Sticky Thai Rice (with coconut & sesame seeds) 1 chicken satay 1 diet soda880 (28 grams of fat) 390 (24 grams of fat) Snack3:00 PM 1 large Mrs. Field’s chocolate chip cookie + 1 cup water 280 (13 grams of fat)Dinner7:30 PM1 hamburger with cheese w/bun 1 small order French fries 1 chocolate milkshake 240 (17 grams of fat) +120 220 (12 grams of fat) 360 (11 grams of fat) Calories Out (energy expenditure)NoneTotal Calories In = 3,075 (38% from fat)1. What did her food logs reveal? 2. Nutrition Assessment: Upon looking at the composition of C.C.’s diet, what does it reveal?3. Nutrition Recommendations: What are your recommendations for C.C?4. Food Log Makeover (according to the new Dietary Guidelines for Americans (taking into account the same activity level)MondayCalories In (calculated by the RD)BreakfastSnack lunch SnackDinner Total Calories In = Case Study 4: Liquid Calorie SabotageNameK.C.Age28SexfemaleHeight5’4”Weight162BMI28BMI category (NIH Guidelines)overweightWaist Circumference37”Notes:V.A. presented to a registered dietitian (RD) at her physician’s recommendation. Her medical history was stable, however over the last 5 years her total cholesterol (LDL is in range; HDL is slightly low) has been climbing and her fasting blood sugar, although still in a healthy range, has gone up, too. She has been experiencing peri-menopausal symptoms, such as night sweats, unusually frequent cravings for sweets, and recent weight shifting from hips to abdominal area. She never had to “watch” what she ate (or drank) – until now.Upon nutrition assessment the RD noted that V.A. has a hard time recalling her food intake. She especially could not remember drinking, however, after some thought she could recite a typical day. For some reason, V.A. did not consider beverages into her daily calorie scheme. It turned out that she drank more than she thought. She always drank with meals and never drank diet beverages because she didn’t like the taste of sugar substitutes. She was trying to increase her dietary fiber (because she was aware of her cholesterol levels). She just started to work with a personal trainer on strength training and she is taking one-hour walks daily.Name V. A.Age 47Sex femaleHeight 5’8”Weight 170BMI 26BMI category (NIH Guidelines) OverweightWaist Circumference 34”Let’s take a look at a typical day.V.A.’s Food Log SaturdayCalories In (calculated by the RD)Breakfast6:00 AM 2 cups bran cereal, 1⁄2 cup low-fat milk16 oz. orange juice, 1 cup coffee with vanilla-flavored coffee mate (2 Tbs)180 + 65= 245230 80Snack9:30 AM1 cup coffee w/ vanilla-flavored coffee mate (2 Tbs) 8 oz water80Lunch12:00 PM2 pieces whole grain bread, 4 Tbs. egg-white salad, 1 Tbs. lite mayo, celery & onion, 20 oz. bottle SoBe Green/Lemon Iced tea (sweetened)200 + 20 + 50 + 10 = 280220Snack2:00 PM1 hot chocolate w/ whole milk200Dinner7:30 pmHealthy Choice Lasagna Bake Side salad w/ lettuce, tomato, cucumber w/ 1 Tbs light vinaigrette 8 oz. glass red wine270 + 20 + 45 = 335180Dessert 9:30 PMHot Toddy (2 oz. liquor)200Total Calories In = 1,970 Liquid cals = 1,110Activities1 hour walk (light)Calories Out (energy expenditure)Total calories Out: 240 Calories In – Out = 1,7301. What did her food logs reveal? 2. Nutrition Assessment: Upon looking at the composition of V.A.’s diet, what does it reveal?3. Nutrition Recommendations: What are your recommendations for V.A?4. Food Log Makeover (according to the new Dietary Guidelines for Americans (taking into account the same activity level)SaturdayCalories BreakfastSnacklunch SnackDinnerActivity Total Calories In =