Chelsea Moffett

Case Study #2
Professor Dray
October 30, 2014

Answer the following questions for Case study #2

1. Describe the stages of readiness for change, and identify where you think she falls on this continuum.
(4 points)1
Ms. G would fall under the first stages of change, precontemplation, where this change shows that the
patient is not ready to change or is denying that they have a problem. Ms. G seems unmotivated to change her
lifestyle as she has said that she has tried to use different weight loss plans, but was unable to achieve the results
she wanted. If we were able to see how long Ms. G was trying out each of her weight loss plans, it would be a
better indication if she was motivated to stick with these certain diet plans. Ms. G has not mentioned to her
doctor that she is willing to make a change in her lifestyle yet, which would still leave her in the
precontemplation stage of readiness model.
The other stages of readiness for change are contemplation, preparation, action, and finally,
maintenance. Contemplation is when the person is thinking about making a change, usually within the next six
months. In the step of preparation, the person actively decides to plan and change, usually within a months
times. In the action stage, the person is trying to make the desired change and has been working at making the
change for less than six months. Finally, in the maintenance stage, the person has sustained the change for six
months or longer, this change has become part of their normal routine.

2. Calculate her BMI. How would you interpret it? How does her waist circumference measurement add
to your assessment? (4 points)
Ms.Gs BMI is (189/(66 x 66)) x 703) = 30.5 %
Interpreting Ms. Gs BMI results, this indicated that she is currently obese for her height and
weight. While the overweight category ends at 29.9 %, it seems that Ms. G possibility of losing weight
and not being in the obese category are a high chance for her if she is to stick to a well-balanced diet and
exercise as well. Ms. G would only have to lose 0.6 % of her BMI results to longer be considered obese.
Her waist circumference is currently 38.5 inches, which indicated that she is at a greater risk for obesityrelated diseases. A women is not supposed to have a waist circumference higher than 351, this put the person at
risk for metabolic syndrome, type 2 diabetes, cardiovascular, and many more obesity-related diseases. If Ms.Gs
BMI was only in the obese category without an increase waist circumference, her chances of disease risk would
be high. However, since Ms. G currently has a high BMI in the stage I category of obesity and a waist
circumference higher than recommended, her chances of disease risk has increased to very high.
3. What does her history of giving birth to heavier than average babies suggest? (4 points)1
Her history of giving birth to heavier than average babies suggest that Ms. G might have had gestational
diabetes when pregnant. If a baby weighs more than 8.8 pounds, the baby is then considered to be higher than
normal range for child birth. During gestational diabetes if Ms. G was to experience this while pregnant,
uncontrolled blood sugars will increase the babys weight since the babys main fuel is glucose from the
mother. With the mother having consistently high blood sugars, this results in a high weight baby. Assuming
that Ms. G was not obese when pregnant and was overweight, her normal weight gain should have only been
15-25 pounds1, rather than the 50 pounds of weight that was gained by the patient during pregnancy. This
excessive weight gain during pregnancies could also be an indication of her babies being heavier than average
at birth as well.
4. Does she meet the criteria for this syndrome according to the National Cholesterol Education Panels
Adult Treatment Panel III? How is metabolic syndrome treated with diet and physical activity? (4 points)
According to the National Cholesterol Education Panels Adult Treatment Panel III3, Ms. G meets this
criteria of metabolic in the following described ways. Metabolic syndrome consists of having at least three of
these symptoms to be diagnosed with this syndrome. The first one is a larger waist line, Ms. G currently has a

larger waist line at 38.5 inches in comparison to the 35 inches that is recommended for women. The next factor
is high triglyceride levels, Ms. Gs current lab result show that her triglyceride level is 200 mg/dL, which is
considered of high triglyceride levels; the normal range is 150 mg/dL or under. Another risk is low HDL
cholesterol level, which anything under 50 mg/dL is considered poor control, which the patients lab results
show that her HDL level is only at 38 mg/dL. High blood pressure is going to be the next risk in metabolic
syndrome, Ms. Gs current blood pressure is 135/80mmHg, which is out of the normal range of 130/85. The
final risk factor is high fasting blood glucose levels. The normal fasting blood glucose level is between 70
mg/dL to 100 mg/dL, the patients fasting results are 120 mg/dL, which is an indication of prediabetes.
Examining each factor of metabolic syndrome, Ms. G currently meets all five risk factors which means that she
is more at risk for developing type 2 diabetes, cardiovascular disease, and other diseases due to obesity and poor
lab results.
Metabolic syndrome is treated through exercise because it allows the patient ways to lower more than
one of their risk factors of metabolic syndrome. One of the risk factors that exercise allows to be reduced is
waist circumference. By exercising daily, the patient is able to lose weight, which allows the waist
circumference to decrease. Also, by exercising, a patient who has metabolic syndrome is able to help their body
become less insulin resistant. Studies shown that just by losing ten pound of weight, insulin resistance is helped
and the body can recognize insulin better than with the weight on. Blood pressure is also lowered by taking part
in daily exercise, our patient would need to utilize exercise to help lower her current blood pressure of
135/80mmHg.
Diet is an important part in treating metabolic syndrome. Diet is able to help every single risk factor of
metabolic syndrome, which is why including a healthy diet in a patient with metabolic syndrome is vital. By
including a healthy diet, a patient is able to include healthy fats, which raises a person HDL cholesterol level
back to normal range. Including healthy fats such as olive, canola, peanut oils, avocados, nuts, and fish are all
great ways for a person to improve their HDL levels.1 Since a person with metabolic syndrome also includes
high triglyceride levels, diet is one of the best ways to lower these results in a patient. A healthy diet for the
patient will include less sugars, less saturated fats, less refined grains, and less calories. All of these limitations
in a patients new healthy diet, will help lower overall triglyceride levels and reduce this risk of metabolic
syndrome. Through diet and exercise, a patient who suffers from metabolic syndrome is able to reduce all risks
through a new lifestyle, which includes a healthy diet and daily exercise.
5. What can you do to help her become motivated from within herself to change her diet and exercise
behaviors? (4 points)
Some ways to help motivate Ms. G are letting her know what might become of her future, if diet and
exercise are not included in her lifestyle. In some cases, patients do not believe that their life is as unhealthy
until they see lab results and numbers that show that they are not as healthy as they can be. By letting Ms. G
know that she has metabolic syndrome and what can result from this, it allows Ms. G to see what might happen
later on in life if she is to continue her lifestyle the way it is.
Examples to include for Ms. G to motivate her new lifestyle of healthy eating and exercise is to help her
find some foods that she enjoys and work that into her meals. By making her foods enjoyable, she is going to be
more motivated to continue to choose healthier options knowing she can still eat some of the items that she
enjoys. Explaining to her that exercise doesnt have to be spending hours on end at the gym, rather she is able to
work exercise into her schedule. Including exercise by walking around for ten minutes during her lunch break at
work, swimming in a pool, or playing with her children are all great ways to work exercising and motivation
into Ms. Gs lifestyle. By making healthy eating and exercise seem feasible to Ms. G, it allows room for her to
be more motivated she will be able to work these changes into her current lifestyle without stress.
6. Assuming she becomes ready to take action, identify some initial steps that she might take to improve
her diet. (4 points)

Some initial steps to changing Ms. Gs diet would be to start slowly and change a few things at a time in
her usual diet. One would be replacing all refined grains with whole grains, since this will add more fiber to her
diet and reduce her chances of developing type 2 diabetes or cardiovascular disease. The next step that I would
take with Ms. G would be to remove all juice from her diet since these are full of pure sugar and replace them
with fresh fruits. Another step that I would take with Ms. G to better her diet would be changing her whole milk
option to skim milk, where there is less fat for her to intake in her diet. A big step that I would try and take with
Ms. G would be to make sure she doesnt skip breakfast! The reason for this is because if she is going to bed
around 9, she would ultimately be fasting for over 12 hours in her day till lunch. Her Starbucks coffee provides
her nothing but sugar and caffeine and no nutritional benefits. Below would be some modifications to her usual
diet reported that would benefit her diet.
BREAKFAST: Instead of skipping breakfast --- Fresh fruit, skim milk, whole wheat toast with cheese
SNACK: Almonds and water (WAS--PASTRY AND BOTTLE WHOLE MILK)
LUNCH: PEANUT BUTTER AND JELLY SANDWICH ON Wheat bread (WAS--WHITE BREAD) WITH
FRUIT AND A Water (WAS---COLA)
.
AFTERNOON SNACK: Greek yogurt with granola and water (WAS--OREO COOKIES AND JUICE)
DINNER: Turkey Burger on a wheat bun or baked chicken (WAS---HAMBURGER OR CHICKEN), Dry
sweet potato (WAS---POTATO SALAD OR SCALLOPED POTATOES) Asparagus or squash (WAS--CORN
OR PEAS) Salad with oil and vinegar (WAS---TOSSED SALAD WITH RANCH DRESSING) Angel food
cake with strawberries or sugar free pudding/jello (WAS--PUDDING, JELLO OR BROWNIE.) DRINKS
WATER.
EVENING SNACKS: Whole wheat pita chips with hummus dip and water (WAS---CHIPS, DIP AND JUICE)

7. What is the role of physical activity in weight loss and weight maintenance? How do aerobic activity,
strength training, and stretching all contribute to optimal weight management?
(4 points)
Moderate physical activity, defined as 30 to 45 minutes of brisk walking on most days of the week is
recommended as therapy for those with metabolic syndrome. Exercise is strongly associated with success in
weight-reduction and weight-maintenance, any increase in activity level is strongly encouraged to help with
optimal weight management. Moderate-intensity physical activity lasting 60-90 minutes is recommended for
individuals trying to maintain a new lower weight after have having lost weight. For weight loss for the patient,
five days a week is recommended for optimal weight loss to succeed in most cases.
Aerobic exercise may make you tired in the short term. But over the long term, you'll enjoy increased
stamina and reduced fatigue.5 Ms. G currently stated that she has been feeling fatigue lately, which could be due
to her lack of aerobic activity levels. Aerobic activity helps with optimal weight management, strength training
though helps keep muscles built up. It is important to include strength training alongside with aerobic activity to
keep muscles built up and not completely breaking muscles down. Stretching helps optimal weight management
is for the reason that by stretching, it allows the body to be more pliable before and after exercise. Stretching
also allows the person to become less prone to injury during exercise. If a person does not stretch before and
after exercise and injury happens during exercising, the person will not be able to continue their daily exercise
program, which would not allow optimal weight management.
8. What methods would you suggest she could use for self-monitoring? (4 points)1
Methods that I would suggest that Ms. G use for self-monitoring are using structural meal plans, goal
setting, problem solving, and social support. More great methods for her to use would be keeping a food and
activity log this way she able to keep track of what foods she is consuming and how often she is participating in

exercise and for how long. Another self-monitoring method she is able to use is regular weigh-in of her
progress. By participating in regular weigh-in, this allows Ms. G that change is happening in her lifestyle
choices, which is a great way to keep her motivated.
9. Make suggestions for handling family meals, special occasions, and holidays. (4 points)
When handling family meals, I would suggest that Ms. G plan ahead for the family meals of the week.
By writing down what each day and each meal will consist of, this will better her grocery shopping experience
by not purchasing food she doesnt need and will also allow her to eat more home cooked meals. Planning out
meals ahead of time causes less stress on the family, while allowing healthy home cooked meals to be included
in the diet of herself, as well as her family.
For special occasions and holidays, my suggestion would be to watch portion controls. On holidays such
as Thanksgiving, sometimes we as people forget what a normal size plate consists of and continue to indulge in
food till we can no longer move. If Ms. G is able to be self-motivated and stick to her goals, it is vital that she
continue her new lifestyle every day, not only when she wants to. This would include holidays and special
occasions and to stick with it on these days. The reason for not taking a day to indulge in crazy amounts of food
for someone like Ms. G is because it is easy to fall of the bandwagon and revert back to old ways.
Another way that Ms. G could feel included in special occasions and holidays is by bringing her own
potluck dishes to these outing. This is a warm gesture for the host of these events, as well as it allows her to
plan to bring a healthy meal for her to enjoy as well as everyone else who will be at the event.
10. Write a PES statement based on her initial presentation. How would you monitor and evaluate the
effect of your interventions? (4 points)1, 6
Excessive fat intake related to lack of healthy diet options as evidence by patients BMI calculation of
30.5%, waist circumference of 38 inches, and food history provided.

Meals from 10/30/14 - 11/03/145

Ms. G's Meals

Your plan is based on a 1500 Calorie allowance.

Date

10/30/14
Calories:
1494

Breakfast

Lunch

Dinner

1 regular slice
Bread, 100%
whole wheat

1 cup, sliced Avocado,

raw

1 ounce(s)
Cheese, Blue or
Roquefort

1 slice (1 oz)
Cheese,
Cheddar,
reduced fat

2 regular slice Bread,

100% whole wheat

1 medium breast
Chicken, breast,
boneless, skinless,
baked

1 medium (25/8" across)

1 slice (1 oz) Cheese,

Swiss, low fat

3 wedge or slice
Lemon, raw

Snacks
1 ounce (22
almonds) Almonds,
dry roasted, without
salt

1 cup (8 fl oz)
Water, tap

Orange, raw
1 cup (8 fl
oz) Water, tap

1 cup Edamame, frozen,

cooked (no salt or fat
added)

1 medium roll (21/2" across) Roll,

100% whole wheat

1 tablespoon Mayo, lowcalorie or diet (Light

Mayonnaise)

1 cup Spinach, raw

2 medium slice (3" x 2" x

1/4") Turkey, white meat,
roasted, skin not eaten

1 cup, whole
Strawberry, raw

1 cup (8 fl oz)
Water, tap

10/31/14
Calories:
1488

11/01/14
Calories:
1430

1 cup (8 fl oz)
Water, tap

medium (7"
to 7-7/8" long)
Banana, raw

1 cup, shredded Cheddar

cheese, low fat

1 cup Jello
(gelatin) dessert,
with low calorie
sweetener, with
fruit

2 tablespoon
Almond butter

tablespoon
Flax seeds

1 medium breast Chicken,

breast, boneless, skinless,
baked

cup Quinoa,
cooked

1 medium (2-3/4"
across) Apple, raw

1 cup Oatmeal,
multigrain,
cooked with
milk, without
fat

1 cup Green beans, fresh,

cooked with mushroom
sauce

1 cup, slices
Squash, summer
(yellow or
zucchini), fresh,
cooked (no salt or
fat added)

1 mug (8 fl oz)
Tea, brewed,
unsweetened,
decaffeinated

1 tortilla Tortilla, whole

wheat

4 ounce(s) Tofu,
extra firm

1 cup (8 fl oz) Water, tap

1 cup (8 fl oz)
Water, tap

2 regular slice Bread,

100% whole wheat

1 cup, cut stalks

Broccoli, fresh,
cooked (no salt or
fat added)

cup
Blueberries,
raw

5 ounce(s) Carrot,
raw

1 tablespoon
Coffee
creamer, light,
liquid

2 slice (1 oz) Cheese,

Cheddar or Colby, low fat

1 piece (1/12 of
tube cake) Cake,
angel food, no
icing

1 mug (8 fl oz)
Coffee,
brewed,
decaffeinated

2 medium slice (1/4" thick)

Tomato, raw

1 medium steak
Steak, beef, grilled
or broiled, lean
only eaten

cup Granola,
lowfat

cup, whole
Strawberry, raw

1 container
(6 oz) Greek
yogurt, plain,
fat free

1 medium potato
(5" long) Sweet
potato (yam),
baked (no salt
added), peel not
eaten

cup
Raspberry,
red, raw

cup Whipped
cream, fat free,
pressurized
container

2 tablespoon
Hummus

1 cup (8 fl oz)
Water, tap

1 cup (8 fl
oz) Water, tap

11/02/14
Calories:
1456

medium (7"
to 7-7/8" long)
Banana, raw

small stalk (5" long)

Celery, raw

1 cup Asparagus,
cooked (no salt or
fat added)

5 small cube
Cheese, Cheddar,
reduced fat

1 cup
Cheerios
Cereal

1 ounce(s) Cranberry,
dried

1 cup Chocolate
pudding, sugar
free dry mix, with
whole milk

1 cup Pretzel,
hard, multigrain

1 cup Milk, fat

free (skim)

1 cup, shredded or
chopped Lettuce, mixed
(mixed greens, salad mix,
spring mix), raw

cup Lettuce,
arugula, raw

2 tablespoon
Raisins

can (6.5 oz), drained

Tuna, canned, water pack

2 tablespoon
Salsa, red, cooked,
ready-to-serve

1 cup (8 fl
oz) Water,
tap

1 cup (8 fl oz)
Water, tap

2 tablespoon Sour
cream, light

1 cup (8 fl oz)
Water, tap

2 small chappatti
or roti (6" across)
Tortilla, whole
wheat
1 cup, cooked
Turkey, ground,
cooked
1 cup (8 fl
oz) Water, tap

11/03/14
Calories:
1492

2 tablespoon
Cheese,
Cheddar, dry,
grated

2 regular slice Bread,

100% whole wheat

cup, crumbled
Cheese, Feta

1 cup Cheese,
cottage, low fat (12% fat)

1 large egg
white Egg
whites,
cooked, no fat
added

1 cup, chopped Broccoli,

raw

1 medium breast
Chicken, breast,
boneless, skinless,
baked

cup, sliced
Mango, raw

1 muffin
English muffin,
multigrain

1 tablespoon Hummus

2 medium scoop
Ice cream, fat free
(nonfat), no sugar
added, vanilla or
other flavors

1 cup,
seedless
Grape, raw

1 tablespoon Jelly,
reduced sugar, all flavors

1 medium roll (21/2" across) Roll,

100% whole wheat

2 tablespoon Peanut
butter, reduced fat

1 cup Spinach,
fresh, cooked (no
salt or fat added)

1 cup (8 fl
oz) Water,
tap

1 cup (8 fl oz)
Water, tap

1 small/thin slice
Tomato, raw

1 cup (8 fl
oz) Water, tap

1 cup (8 fl oz)
Water, tap

Day One5

Day Two5

Day Three5

Day Four5

Day Five5

References (AMA format)

1. Mahan LK, Escott-Stump S, Raymond JL et al. Krause's Food & the Nutrition Care Process. Elsevier
Health Sciences; 2012.
2. Choose My Plate: Sample Menu. http://www.choosemyplate.gov/foodgroups/downloads/Sample_Menus-2000Cals-DG2010.pdf. Accessed on October 30, 2014.
3. National Heart, Lung, and Blood Institute: Third Report of the Expert Panel on Detection, Evaluation,
and Treatment of High Blood Cholesterol in Adults. http://www.nhlbi.nih.gov/healthpro/guidelines/current/cholesterol-guidelines/index.htm. Accessed on October 30, 2014.
4. Mayo Clinic: Aerobic exercise: Top 10 reasons to get physical. http://www.mayoclinic.org/healthyliving/fitness/in-depth/aerobic-exercise/art-20045541. Accessed on October 30, 2014.
5. Choose My Plate: Supertracker. https://www.supertracker.usda.gov/. Accessed October 30, 2014.
6. International Dietetics and Nutrition Terminology (IDNT) Reference Manual: Standardized Language
for the Nutrition Care Process. 4th ed. Chicago, IL: Academy of Nutrition and Dietetics; 2013