Written Assessment and Care Plan

E.C. is a 23-yer-old, white female, who graduated from Cal Poly last fall as
a kinesiology major.

She is now working full-time, 8 hours a day, as a physical

therapy aid. She is still getting used to her long work hours, which don't leave
her the energy and time to work out as much as she did back in college. She
lives by herself and enjoys doing her own grocery shopping and cooking. She
has a family history of heart disease, diabetes, high cholesterol, and high blood
pressure, but she is personally very healthy and makes eating well a priority.
She doesn't have any allergies and is taking biotin supplements to improve her
hair and nail growth.
By the way that E.C. described herself and the changes she wanted to
make, I could tell that she is a little over critical of herself and a bit of a
perfectionist.

Even though she is very healthy and a good weight, she is

constantly criticizing the few areas with room for improvement. She describes
the way she eats or drinks with her friends on weekends as awful or terrible
but then when I actually ask her to write down what she ate it isnt nearly as bad
as she makes it sound.

She wont let herself have any misstep without

emphasizing it or verbally punishing herself. I dont think this is the healthiest

mindset so I tried to focus on emphasizing her success and all the positive things
she does for her health. However, knowing E.C. for a couple years now, I know
that this is simply how she keeps herself motivated and on track with her goals
both in her career and her lifestyle.
E.C. is knowledgeable on healthy eating and portions and takes this as a
priority in her everyday life. She does view her new, long work days as a barrier
and added stress to her life that has thrown off her usual routine of working out
daily like she did in college. E.C. works from 8am to 5pm and claims that she
rarely has the energy or motivation to go to the gym after a long day of work.
She manages about 30min at the gym twice a week, but is on her feet all day at
work rehabilitating patients. Although she eats healthy, E.C. would like to
increase her physical activity to prevent weight gain. She also mentioned that
working out regularly improves her mood and overall energy level.

E.C. is concerned about gaining weight due to stress from work and not
getting enough physical activity.

She knows she consumes more alcohol

throughout the week than she should and is worried that those calories will start
adding up and cause her to gain weight. So, she would also like to work on
limiting her alcohol consumption throughout the week to prevent weight gain.
I assessed E.C.s readiness by asking her on a scale of 1-10 how ready,
confident, and important making these changes are to her. For increasing her
physical activity, E.C. answered 10 for both readiness and importance, and 8 for
confidence. I asked her why confidence was lower than the other two, and she
just explained it was because of her busy work schedule and lack of
energy/motivation after work.

As far as the decreasing alcohol consumption

throughout the week, E.C. answered 6 for readiness, 8 for importance, and 5 for
confidence. She said this was because it is very difficult for her to resist having
another drink when she is out having fun with friends and everyone else is
drinking. However, it is something that is important to her and that she wants to
work on.
E.C. complies to many of the national goals for diet, exercise, and fitness
including maintaining a caloric balance to sustain a healthy weight, consuming a
variety of fruits and vegetables, consuming most of her grains trhough whole
grains, and avoiding must high sodium and high fats foods. However, she falls
short of the national goals for physical acticity and exceeds the goals for alcohol
consumption. E.C. cooks most of her food at home and makes healthy choices
when eating out, which allows her to consume an appropriate amount of sodium
and cholesterol in her diet, especially compared to most Americans.
E.C. is 57 and weighs about 135lbs, which is 100% of her ideal body
weight. She has a BMI of 21.2kg/m^2, which is within the normal range of 18.524.5kg/m^2. She is able to maintain a healthy diet, even with her schedule, and
claims to eat about every 3 hours. Her favorite foods are meat and fruits. Her
typical breakfast is an egg sandwich, on whole wheat toast, with avocado,
tomato, and Canadian bacon. She packs healthy snacks like fruits, vegetables
and hummus, and power bars for work. For lunch she usually has a salad or

sandwich and a typical dinner would include lean meat like chicken and steamed
vegetables. She stays hydrated throughout the day, drinking mostly tea and
water, and tends to stay away from sweets. She drinks alcohol around 3
nights/week, averaging about 3 drinks each time. She only eats out about twice
a week and tends to stick with healthy options like Panera salad or Natural Cafe.
E.C.s dietary assessment was appropriate compared to her nutritional
recommendations for her age and health status.

Her 24-hr recall, analyzed

through SuperTracker on MyPlate.gov, showed that she consumed around

1900kcals compared to her recommended 2000kcals. She is consuming enough
fruits and vegetables, lean protein, and grains, but doesnt get enough dairy and
is consuming too many empty calories.

Even though her analysis says she

consumes too many refined grains, typically almost all of her grains are whole
grains. She gets most of her dairy from cheese and should incorporate more low
or nonfat milk into her diet, as she does not like the texture of yogurt. She is also
very low on oils and should incorporate them into her cooking. I think E.C.s
biggest concern is her excess consumption of empty calories, which typically
would be even higher on days where she has multiple alcoholic beverages. Her
food frequency questionnaire gives a better general idea of her typical
consumption than the 24-hr recall. As reported on the FFQ, E.C. consumes
almost twice as many whole grains than refined grains, plenty of fruits and
vegetables, 1 or 2 serving of low fat dairy, leans meats daily, a few higher fat
meats throughout the week, and about 10 alcohol beverages throughout the
week, which is her biggest dietary concern.
E.C.s percent calories from her 24-hr recall are high in sodium, saturated
fat, and cholesterol, which are of concern because that runs in the family.
However, I dont think this is typical of her usual consumption because she
doesnt usually have cheese twice a day, or multiple servings of crackers or
wheat thins. Her analysis shows that 26% of her kcals come from fat, 53% from
carbohydrates, and 18% from protein. The protein is a little high compared to her
recommendation, but for the most part these values are close to her
recommended intakes and she a a healthy and balanced diet. Her analysis

shows that she consumes a lot of fiber, which is good, and probably comes from
all the fruits, vegetables, and whole grains she consumes.
Reported calories are almost exactly what MyPlate.gov and national
standards recommended for E.C., which is accurate to her maintenance of ideal
body weight. Her goal is to maintain her healthy weight while adapting to her
new schedule, so her consumption is on track with that goal.

The biggest

change E.C. should make is to swap out her empty alcohol calories with more
nutrient dense foods like low fat dairy, whole grains, seafood, and fruits and
vegetables.
E.C. physical activity before our first meeting was only about 30 minutes at
the gym twice a week. This does not meet the national goals for exercise for
ages 18-64 of 2hrs and 30 min/week of aerobic moderate level or 1 hr and 15
min/week of vigorous level exercise.
During our second session, we talked for about 30 or 40 minutes. She
was very motivated and ready to make the changes necessary to increase her
physical activity and maintain a healthy diet. Due to her kinesiology studies in
college, she had some background knowledge in nutrition and physical activity,
and is aware of their importance in a healthy and balanced lifestyle. She is very
busy and stressed trying to adapt to her new job and busy schedule, but is
dedicated to making these changes in her life. Over the next couple of weeks
she managed to maintain her usual healthy eating patterns for the most part,
besides eating and drinking more at social events on weekends. She only made
it to the gym twice in the past week and said she would like to increase this
number to about 4 times a week. Though she didnt report any weight gain, this
was still a concern for E.C. and she would like to prevent this and improve her
energy level and mood through more physical activity.
I provided E.C. with an overall eating plan appropriate for her goals of a
balanced diet with increased physical activity. I did this through creating a profile
for her on ChooseMyPlate.gov and providing her with a detailed outline of
calorie, and food group recommendations per day. She is supposed to adhere to
a 2000-calorie diet, with less than 258 empty calories (which she exceeds in

alcohol every week).

I researched Biotin supplementation and provided her with the
information. There are no known risks or toxic levels of biotin. She probably
consumes enough through her well-balanced diet but it isnt a big concern to her
health.
We thoroughly discussed exercise goals and benefits. I provided her with
Potential Benefits of Regular Physical Activity handout, of which many of the
points were very applicable to her life, especially enhancing mood and selfimagine and reducing stress. I had her fill out the Physical Activity Readiness
Questionnaire, which she passed indicating that she is ready to become more
physically active. I also provided her with a Physical Activity Options handout
that gave her tips on incorporating ore physical activity into her usual daily
routine. I gave her a Physical Activity log so that she can be accountable and
track her progress with physical activity as well as signed her in to the Physical
Activity Tracker on MyPlate.gov.
One of E.C.s goals was to go to the gym at least 4 times a week for 30
min. She chose this goal because it is concrete; she is kind of a perfectionist so
she wont let herself not complete something. If she gives herself a concrete
number and time that she must perform physical activity, she is more likely to get
it done. She is also a person who sticks to a routine. So, if she gets into the habit
of going to the gym 4 times a week, she is likely to maintain this routine. Her
second goal was to reduce alcohol consumption to 2 drinks twice a week.
Increasing her physical activity is important to her to prevent weight gain,
improve her mood and self-image, and give her more energy throughout the
week. The stress and longs hours of her new job make her want to enjoy her
weekends even more so she has been drinking more than usual and more than
she should lately. She is worried that this increased alcohol consumption will
lead to weight gain, especially combined with her decreased physical activity
after college. She would like to limit her alcohol consumption in order to prevent
weight gain and to decrease the amount of empty calories she is consuming
every week.

E.C. made great progress over the next week on her first goal. We sat
down and discussed the last week and a half and any barriers she has to
achieving her goals. We looked at her Physical Activity Log and her Physical
Activity Tracker on MyPlate.gov to review how she has been doing since our last
visit about a week and a half ago. Since I had seen her last, she logged gym
physical activity time about 6 times (around 4 time a week) for about 30 minutes
each time, like we had discussed. She claimed that her weight had been stable
and that although it didnt always sound great to go to the gym after working all
day, she felt much more confident, more energized, and in an overall better
mood after she went.
She claimed that her second goal had been a little more difficult to stick
to. She only drank alcohol twice in that week but had 3-4 drinks each time
because she was at an all-day BBQ one of the weekend days, and went wine
tasting on the other. So, barriers to accomplishing her second goal include the
social events that she attends on weekends, and the consumption of her peers
around her, which gives her less control and motivation to stick to her 3 drink
goal.
Keeping a Physical Activity log and tracking her progress online on
MyPlate.gov worked really well for E.C.

It has kept her motivated and

accountable for her goal and forced her to stay on track. However, we discussed
that the barriers of social events and the influence of her friends on weekends
had kept her from achieving her second goal. I found rethinking drinking
handout to give to E.C. so that she could calculate the average number of
calories she consumes through alcohol each week. The total came up to be
about 1250kcals, which really shocked her and further motivated her to stick to
her goal next week. For this reason we wanted to come up with some way to
keep her accountable for this goal as well. E.C. came up with a revision of her
second goal that is more realistic to her lifestyle. She decided to allow herself 4
drinks a week (just like the first goal), but decided that she could choose how and
when to disperse these drinks throughout the week. So, if she decided to go to
an all day BBQ again and chose to have all four of her drinks throughout the day,

then she wont drink alcohol for the rest of the week. Instead, she will drink ice
tea or lemonade while her friends are drinking or offer to be the driver for the
day/night.
Because she wasnt gaining weight and her alcohol consumption wasnt a
serious threat to her health, this second goal had been a harder one for E.C. In
order to keep herself accountable she vowed to set her alarm on days she would
go out with friends so that while she is drinking she has a reminder to stick to her
goal. Every time she would consume an alcoholic beverage she would log it in
the same binder as her physical activity to show to me at our next visit.
After reviewing her physical activity log and physical activity tracker print
out, I was happy to see that E.C. met and exceeded the national goals for
exercise. She is now performing a level of exercise that is beneficial for her goal
of weight maintenance and overall heart and bone health.

Based on E.Cs

success with her first goal, we both decided to slightly step up her physical
activity goal for the next week to 5 times a week for 40 minutes each. Based on
the barriers E.S. experienced achieving her second goal, we revised it to make it
a little bit more flexible: 4 alcoholic beverages per week, to be distributed as E.C.
chooses.
I think the readiness measures in our first meeting accurately predicted
E.C.s performance. She was very confident and ready to increase her physical
activity, which she did successfully and gradually until achieving her goal. She
was less confident about limiting her alcohol consumption, which proved to be
accurate when she had trouble sticking to her goal the first weekend. However,
because E.C. refuses to fail, she was able to find a method to keep herself
accountable and achieve her second goal as well.
After meeting with E.C. for the last time, I was very pleasantly surprised to
find that she had met both of the goals we set up at our previous meeting. She
made it to the gym or performed some sort of physical activity at least 5 times a
week for 40 minutes and said she has been feeling more confident and healthy
than ever. She also stuck by her 4 drinks per week goal, having two drinks on
each of two occasions. E.C. was very proud of herself for accomplishing her

goals and this was the first meeting that she didnt focus on being critical of
herself, and instead was able to focus on her successes.
I am very confident that E.C. will be able to continue these goals long term
because I have seen her grow over the past month or so and I know that she is a
person of routine. Even if she has an extra drink here or there, I know that
seeing how many calories alcohol is contributing to her intake every week gave
her greater awareness and determination to cut back because her health and
weight maintenance is a top priority. I think that E.C. has learned a lot and will
continue to improve and implement the goals she has been working on
permanently.