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How to Complete On Your Own D:

Assess your Client’s Needs and Risks
Use the relevant client information—Recorded Interview, Diet and Exercise Journal, completed Client Questionnaire and Customer Satisfaction Survey—to analyze your client’s needs and risks.

Create a Healthy Eating Guide
Use the Questionnaire, Diet and Exercise Journal, your Needs and Risks Assessment and the Guidelines for Recommended Servings document to create a Healthy Eating Guide for your client. You may share the Healthy Eating Guide with your client once your mentor reviews it and gives you permission to do so.

There are two deliverables that are unique to this task. Each needs to be completed on a schedule, so be aware of the different streams of work that you need to complete in order to gain the deepest understanding of the topics at hand. The steps below will remind you when to submit your work.

 

Assess Your Client’s Needs and Risks
Using the provided Client Assessment Template (like the one you used to assess Jay Carter in Task 1.2: Assessing Client Needs and Risks), analyze your client’s nutritional needs and risks. You may refer to your Recorded Interview, Diet and Exercise Journal, completed Client Questionnaire and Customer Satisfaction Survey, which should provide the necessary data to complete the assessment.

CLIENT ASSESSMENT TEMPLATE QUESTIONS

1. Assess your client’s height and weight measurements and BMI to determine whether they fall within the normal range for his or her age. To do this, you may need to do some research to help you evaluate your client’s height, weight and BMI measurements. You may refer to the FAQ on Assessing Ideal Body Weight and Weight Fluctuations, available in the Resources section (link above).
   
   
   • Does your client’s current height and weight fall within the normal range for their age?
     
     
   • Does your client’s BMI fall within the normal range?
     
     
2. Assess any recent fluctuations in your client’s weight and determine whether they fall within a healthy range. Consider the information your client provided in their questionnaire about their high and low weight range. If you have concerns about any of these areas, what are your concerns, what might be the cause of the problem, and what would be reasonable treatments for the problem?
   
   You may want to reference the materials available in the Resources section (link above), including the FAQ on Assessing Ideal Body Weight and Weight Fluctuations.
   
   
   • Do your client’s high and low measurements in the last 12 months fall within the normal range?
     
     
   • Has your client experienced any abnormal fluctuation in weight in the last 12 months? Explain any issues or concerns with the range of the weight fluctuation.
     
     
   • What was the duration of the weight loss/gain period? How/why might the speed at which the weight was gained or lost be a cause for concern?
     
     
   • Describe any patterns of repeated weight fluctuation that may be unhealthy. What are specific causes of concern?
     
     
3. Assess the context in which your client eats (where, when, etc.) and how it may affect your client’s eating habits.
   • In what ways does your client eat differently depending on when or where s/he eats (e.g. home vs. school; weekdays vs. weekends)? What challenges does your client face in each of those contexts related to, for example:
     
     
     • who chooses the food
     • who prepares the food
     • the amount of food
     • meal times
     • snacking times
       
       
   • Considering these different contexts, what may cause your client difficulty in making appropriate dietary choices? What solutions might help him or her overcome the problems?
     
     
4. Identify any additional outside influences that may affect your client’s nutritional needs and risks.
   
   
   • What peer or familial influences, if any, may be positively or negatively affecting your client’s eating habits and overall nutritional well-being?
     
     
   • Why does your client eat differently at different times or in different settings?
     
     
   • How might these influences present new needs or risks for your client?
     
     
5. Consider your client’s level and type of physical activity. Assess whether or not it falls within the range of what is normal and healthy. You may refer to the FAQ on Guidelines for Healthy Exercise in the Exercise section of the Task Resources to help you calculate your specific exercise needs.
   
   
   • Does your client’s amount of exercise fall within the range of the general recommendations for healthy activity?
     
     
   • Consider the type of physical activity. Is it extreme or intense in nature? Is it high-impact or low-impact? What effect does that have on your client? What effect might it have over time?
     
     
   • What is your client’s attitude toward physical exercise? Is it healthy? Obsessive? How might his or her attitude lead to problems down the road?
     
     
6. Assess your client’s medical condition and history, as it relates to their nutritional well-being.
   
   
   • Does your client have any illnesses or medical conditions? If so, how are they related to his or her nutritional well-being? What specific nutritional needs do they create, if any?
     
     
   • Is your client taking any medications or supplements that may combine with foods in a negative way? If so, how?
     
     
   • Does your client have any allergies? How might they impact his or her nutritional needs or diet plan?
     
     
7. Determine your client’s caloric needs, considering his or her level of physical activity and their personal goals (e.g. weight gain or weight loss). You may refer to the FAQ on Determining Caloric Needs in the Caloric Guidelines for Teens section of the Task Resources to help you calculate your client’s specific needs.
   
   
   • What are your client’s caloric needs for maintaining their current weight?
     
     
   • What are your client’s caloric needs given their weight change goals?
     
     
8. Analyze your client’s current eating habits and patterns. If you determine that your client’s diet is not well balanced, note deficiencies that may indicate potential health risks. (As you note problems or issues in any area, remember to dive into the science to provide evidence for your judgment. Is your client on target for their needs from a biochemical standpoint? Why or why not?)
   
   
   • What is your client’s current caloric intake, based on his or her submitted diet history (Diet & Exercise Journal)? To determine this, you may refer to the calorie calculator in the Caloric Guidelines for Teens section of the Task Resources.
     
     
   • Does your client’s diet reflect an appropriate balance in terms of the percentage of calories that come from protein, carbohydrates and fats? (Look at overall balance as opposed to adequate amounts of each type, which is addressed in the next bullet). Refer to the site about Dietary Calories from Protein, Carbohydrates, and Fats in the Diet and Nutrition section of the Task Resources for guidelines regarding the percentage of calories needed from each of these nutrients.
     
     
   • Determine whether your client is getting enough protein (as opposed to carbohydrates and fats). To do this, calculate the protein your client consumes according to their history by looking up each individual food your client listed in their diet history and determining how much protein it contains. Then determine whether the total is enough given your client’s weight.
     
     
     • A teen needs approximately 1 gram of protein for every kilogram of body weight. If they get more, that is usually not a problem.
       
       
     • Refer to Protein Content of Common Foods in the Diet and Nutrition section of the Task Resources for help calculating your client’s protein intake.

   (The reason you’re calculating whether your client is getting enough protein, but not doing that for carbs and fats is that typically when a person gets enough protein, by default they do get enough carbs and fats.)

   • Does your client’s diet history demonstrate a balanced diet? Compare your client’s diet to the food guide pyramid and note any discrepancies.
     
     
   • Does your client’s diet history include sufficient meals and snacks?
     
     
   • Does your client’s diet history indicate that he or she may be eating too much or too little of any given food or type of food or drink? If you think so, what counts as too much and why?
     
     
   • If you identified any special nutritional considerations (such as medical conditions or food allergies), are they being addressed? If not, explain any discrepancies.
     
     
9. Analyze your client’s goals and concerns related to his or her nutritional well-being.
   
   
   • Consider your client’s goals, including weight change goals and nutritional goals. Are they safe for someone his or her height and age?
     
     
   • Is the proposed timeline for reaching the desired goal reasonable and safe?
     
     
   • Note any lifestyle considerations (e.g., athlete, busy schedule…) and their potential impact with regard to your client’s diet and exercise (e.g., need for more/fewer calories, easy snacks…).
     
     
   • Is your client exhibiting any unsafe behaviors associated with their goals?
     
     
10. Review your assessment to make sure it is complete before submitting it for review.
    
    
11. Submit your assessment of your client’s needs and risks. Review the checklist located on the Submit your work section of this task and submit your Client Assessment Template to your mentor. As you wait for feedback, you should begin creating the Healthy Eating Guide. If your mentor provides revisions on your assessment, you will need to factor those into your Healthy Eating Guide and resubmit your template along with the completed Healthy Eating Guide.
    

 

Create a Healthy Eating Guide

As you develop the guide for your client, keep in mind that there is not one correct way to complete it. People’s tastes and their preferences for certain food groups vary, which is why it’s important for you to gather this information from your client during the nutritional interview. Remember that this guide provides helpful suggestions to your client, and not all suggestions may be followed.

As you get started, first you might want to recommend the foods people tend to under-eat, then the foods they tend to over-eat (being careful to moderate your suggested servings). Midway through the process, do a quick tally to see how many calories you still have to play with, then continue with your serving recommendations for the groups people tend to over-do.

1. First, assess the client’s needs for the food groups that are typically “under-represented”: Milk, Fruit, and Vegetable Groups. The Milk, Fruit, and Vegetable groups each provide important and necessary nutrients that the general population has more difficulty getting into their daily diet, but they are needed in a healthy meal plan.
   
   Compare what your client is eating to what they should be eating in terms of servings.
   
   See the Guidelines for Recommended Servings document in the Resources section.
   
   
   • Using the Guidelines for Recommended Servings, fill in your recommended number of servings for each of these groups in your client’s Healthy Eating Guide. If your client really likes one of these groups (with the exception of the Sweet Group), it’s ok to give them a little more than the recommended amounts, as long as they can get at least the minimum number of servings in each of the other food groups and stay within their calorie limits.
     
     
   • One important exception to keep in mind is if your client is taking a calcium supplement instead of drinking/eating their recommended milk servings or someone who has a physical problem with consuming the Milk group (e.g., lactose intolerance). If this is the case for your client, you could decrease the number of recommended milk servings in their guide, depending on the severity of the issue. In general, if someone has food allergies or dietary restrictions, you need to consider this and adjust your recommended servings appropriately.

2. Next, make your recommendations for the Protein Group. Most people like this group and consume too much of it. It’s important to provide enough protein, but too much is unhealthy. In general, 4-8oz. of protein per day is suggested, depending on the size of the person. Smaller framed people should have closer to the minimum, and larger framed people should have closer to the maximum. Generally speaking, it’s best to stay within the limits provided. Exceptions would be those who are extremely athletic or whose caloric needs are very high. Additional protein for these people would be appropriate as a means to meet their additional caloric needs. For those people who just like to eat more protein, you can provide them with more as long as you do not exceed their calorie level and provide a balance of other food groups.
   
   
3. Do a quick check to see how many calories you have “spent.” Add up the calories you have already provided in the plan so far. For the Milk Group, Fruit Group, Vegetable Group and Protein Group, multiply the number of recommended servings by the number of calories per serving (which you can obtain from your Healthy Eating Guide Template) to get the calories for each group. Then, add the calories for each of those groups to determine how many calories you have already “spent.” Now, review your client’s daily caloric needs, which you should have determined in STEP 5 of the Client Assessment Template.

   For example:

   3 skim milk servings x 90 calories/serving = 270 calories

   4 fruit servings x 60 calories/serving= 240 calories

   2 vegetable servings x 25 calories/serving = 50 calories

   5 oz. protein x 60 calories per ounce = 300 calories

   Total calories “spent” so far = 860 calories.

   In this example, if your client’s caloric needs are 2000/day, then you would have 1140 left to spend on the remaining food groups.

4. Make your recommendations for the Grain Group. Most people have no trouble getting enough of the Grain Group and need to make sure they don’t over-do it on grains. It is recommended that half your servings of grains come from whole grains, as they provide more nutrition from antioxidants and phytonutrients that help fight heart disease and cancer. So, you’ll want to emphasize that your client needs to focus on whole grains as much as possible. You may refer to the Resources section for more information on whole grains.
   
   As pointed out in our Guidelines for Recommended Servings document, you can see that the guidelines indicate most people need between 6-11 servings from this group. Depending on the calorie level that needs to be met and the client’s preference for grains, you now need to determine the number of servings to recommend. Remember that you also need to save some calories for the remaining Fat and Sweet Groups.
   
   Revisiting the earlier example:
   If the client’s caloric needs are 2000/day, then you have 1140 calories to split between the Grain Group, the Fat Group and the Sweet Group. If you provide 8 servings of grain (middle of the recommended serving range), then you will have 8 x 80 calories/serving = 640 calories from this group and you can split the remaining 500 calories between the Fat and Sweet Groups.
   
   
5. Lastly, make your recommendations for the suggested servings in the Sweet Group and the Fat Group. Most people tend to get too much from both of these groups, so you need to keep that in mind as you make suggestions on the guide. A healthy amount of sweet calories for teenagers ranges from 200-300 calories/day. With that in mind, divide up your remaining calories between the Fat Group and Sweet Group, being careful to stay within the recommended parameters for each without going over your client’s total daily calories.
   
   If your client prefers fewer sweets, then be sure to give them less. If you have “extra” calories to play with (i.e., you have not used up your client’s total daily calories) you can revisit the other food groups and add the remaining calories to the groups they prefer.
   
   Revisiting the earlier example:
   Try starting with something in the middle of the recommended range for sweets, i.e. 300 calories. That leaves 200 for the Fat Group, which translates to 4 servings from that group.
   
   
6. Cross-check the caloric needs. Double check your math one more time by comparing the estimated daily caloric needs of the client (STEP 5 of the Client Assessment Template) to the total calculated calories you are recommending for your client in the Healthy Eating Guide. Are the two amounts equal? Or do they fall within 200 calories of each other? This is an acceptable range that indicates your Healthy Eating Guide is on track with your client’s caloric needs. If your calorie totals do not fall within that range, revisit your recommended servings for the various food groups in the Healthy Eating Guide and make appropriate adjustments.
   
   
7. Provide a rationale for your suggestions. After you have completed your recommendations for the suggested number of servings of each food group, provide a rationale for your suggestions on the right hand column of your Healthy Eating Guide. For example, you might say you suggested that you client aim for 7 whole grains a day because they did not have enough grains in their diet according to their diet history, and the Guidelines for Recommended Servings suggested a range between 6-11 whole grains each day.

 

Submit Your Work

1. Review your Healthy Eating Guide to make sure it is complete before submitting it for review.
   
   
2. Review the checklist located on the Submit Your Work section of this task and submit the following documents to your mentor:
   
   
   • Healthy Eating Guide
     
     
   • Client Assessment Template (edited as appropriate if you received revisions from your mentor)
     
     
   • Diet and Exercise Journal (resubmit as a reference for your mentor)
     
     
   • Client Questionnaire (resubmit as a reference for your mentor)

 

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Assessing the Client’s Needs and Risks:

Height and Weight

• Remember that BMI is an indicator of body mass that leaves room for additional interpretation in the case of athletes. That is, an athlete who is very muscular and fit may appear to be overweight based on the BMI standards of what is normal body mass. A practitioner should consider whether a client falls into this category and make allowances when deciding whether or not his/her BMI falls within the normal range.

Weight Fluctuation

• A nutrition advisor should be aware of any dramatic shifts in the client’s weight and look for patterns that could indicate unhealthy behaviors such as severe dieting.

Eating Context and Outside Influences

• A practitioner might overlook the way family or friends may influence the client’s eating behaviors. Rather, s/he should consider the context in which the client eats (when, where, and how much) as well as the outside influences (peers, family, etc.) who may be shaping those habits.
  
  
• Sometimes social relationships can motivate a client in positive or negative ways that can affect his/her well-being. For example, people often make choices to follow their peers (teens are especially susceptible to this). Practitioners should consider any peer or familial relationships the client spoke of and the potential impact they may have in shaping the client’s behaviors and increasing his/her health risks.

Physical Activity

• Practitioners should be aware of extreme behaviors when it comes to exercise. A client who does not exercise at all faces different challenges than a client who over-exercises, but in both cases the level of activity could have a significant effect on the client’s overall well-being.

Caloric Needs

• When determining caloric needs, nutritional advisors should not forget to factor in the client’s exercise habits. Someone who exercises a lot needs more calories to maintain his or her current weight than someone of the same weight who leads a very sedentary lifestyle.
  
  
• Determining caloric intake is not an exact science. It’s best for a practitioner to use a preferred or recommended caloric formula. In addition, s/he should follow the client’s eating habits, see how s/he is progressing toward their nutritional plan, and adjust the level of recommended calories appropriately over time.

Current Eating Habits

• Keep in mind, if a client is skipping meals or skipping snacks, it may or may not be a problem. To evaluate the situation, review Step 8 of the Client Assessment Template Questions in the Step-by-Step Guide.
  
  
• If the client’s diet does not reflect the suggested balance and variety offered by the Food Guide Pyramid, there may or may not be a problem. To evaluate the situation, review Step 8 of the Client Assessment Template Questions in the Step-by-Step Guide.
  
  
• A nutritional advisor should ask a client to track his/her diet history for several days, as opposed to just one day. It is recommended to get at least three days of history, including at least one weekday and one weekend day. This gives the practitioner more information to use when evaluating current eating habits and helps in identifying trends.

Client’s and Parent’s Goals and Concerns

• A practitioner should consider whether the client’s own personality traits or behaviors (e.g. overachiever, recluse, etc.) may be contributing to the risks he faces.
  
  
• Keep in mind that not all goals are healthy. Teens are sometimes influenced by peers to set unhealthy goals.
  
  
• A nutritional advisor should evaluate the client’s goals and parent’s goals independently of each other, but also take time to think about how the two may be interconnected. For example, the parent may have very high standards that could be driving the child’s behavior. The practitioner should consider the potential effect on the client’s well-being.
  
  
• When looking at the data have available to assess the client’s needs and risks, a practitioner may discover that information provided by the parent conflicts with information from the child. This does not mean that one is definitely right and the other is definitely wrong. A practitioner should consider both sides and entertain the possibility that they may both be right, but simply have different (but equally valid) perspectives.

Overall:

• In assessing the client’s needs and risks, a practitioner should consider whether s/he has enough information to develop a good nutritional plan. If not, s/he should identify the details that are lacking.

Creating a Healthy Eating Guide:

• Compare the estimated caloric needs of the client to the total calculated calories on your guide. These numbers should be the same or fall within a range of 200 calories.
  
  
• Don’t forget to consider a client’s likes and dislikes in regards to food groups when creating a Healthy Eating Guide. Try to be heavy where the client likes particular food groups, and lighter where they don’t, while still maintaining balance. At the same time, be sure to stay within the recommended range of suggested daily servings for each group.
  
• Provide your client with several options from the food groups most people don’t get enough of: Milk, Fruits and Vegetables. Be aware of the food groups that people tend to get too much of: Protein, Grain, Sweet and Fat.
  
  
• Take into account any allergies or food intolerances your client may have before creating the guide (i.e. take into account milk allergies in particular, because there are no substitutions. Other allergies outside the Milk Group can have substitutions within that food group.

 

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When referring to a Wikipedia resource, note that while Wikipedia is a valuable resource, unlike some other websites anyone can contribute to or modify the site (whether they're knowledgeable about the topic or not). As a result, the site is subject to constant change by questionable sources. Be sure to cross-check information on Wikipedia with other reputable sites to ensure accuracy.

TASK RESOURCES

Nutritional Planning and Considerations

Ask the Expert: What tips do you have about making a nutritional plan that will work?

Ask the Expert: What are the next steps after the initial client interview, analysis and construction of a nutritional plan?

Ask the Expert: How long do you typically work with a client?

Ask the Expert: Do you ever give up on a client who isn't making progress?

Healthy Eating Guidelines

Guidelines for Recommended Servings - This is a guideline for recommended servings for teens. You may use it as a reference as you create your client's Healthy Eating Guide.

Sample Healthy Eating Guide - This is a sample Healthy Eating Guide that Paula Jansen created for Suzie Kim. You may use it as a reference as you create your client's Healthy Eating Guide.

Height and Weight

How to Assess Ideal Body Weight and Weight Fluctuations - This FAQ outlines helpful steps for assessing a client’s height and weight. It also includes tools and information on interpreting BMI and growth charts.

What is BMI and Why is it Useful? - This site gives you a detailed understanding of Body Mass Index for children and teens.

Exercise

The Benefits of Exercise - This site offers insights into the benefits of exercise for adolescents, including how to start an exercise program, what kind of exercise is best, and how much exercise is enough.

Guidelines for Healthy Exercise - This FAQ addresses questions related to the recommended amount of daily exercise for teens and how much exercise is too much.

Diet and Nutrition

Dietary Calories from Proteins, Carbohydrates, and Fats - The U.S. Department of Agriculture’s Dietary Guidelines offer specific recommendations regarding the percentage of calories needed from key nutrients. See Chapter 5 for guidelines related to protein; Chapter 6 for fats; and Chapter 7 for carbohydrates.

Protein Content of Common Foods - This FAQ provides information on the amount of protein found in various common foods.

Fact Sheet on Whole Grains - This site offers general information on fiber and foods that contain whole grains.

The Truth about Snacking - This FAQ addresses the misconceptions around snacking that exist in today's world.

Why Fiber is an Important Part of a Healthy Diet - This site explains why fiber is good for you and what foods contain fiber.

Easy Ways to Remember Serving Sizes - This helpful handout makes it easy to determine serving sizes of standard foods. You may use it as a resource while tracking your food intake.

Assessing a Client's Diet History - This FAQ explains what a practitioner looks for when evaluating a client's diet history.

Caloric Guidelines for Teens

Ask the Expert: How do you determine which caloric formula is the best to use?

Determining Caloric Needs - Trying to calculate how many calories a person needs is not an exact science. Most of the formulas available today are estimates of caloric needs. This FAQ explains how to determine a teen's caloric needs.

General Calorie Requirements for Children and Teens
Guidelines vary somewhat as to appropriate caloric needs for children and teens. Click on the following links for caloric ranges that can serve as a general guideline. Each site has similar, equally valuable information. It’s best to use these guidelines in conjunction with the FAQ above to determine a client’s specific caloric needs.

• From Weight Loss Resources
  
  
• From Keep Kids Healthy

Scroll half-way down the page to view charts.

Calorie Calculator - A calorie calculator is a helpful tool for determining caloric consumption. Using the tool on the home page, you can plug in the foods and beverages contained in a client's diet history into the calculator and total them to arrive at an estimated number of calories per day.

 

GENERAL NUTRITION RESOURCES

Nutrition Tools & Practices

The Diagnosis & Treatment Process Specific to Nutrition - This document describes a process that health care professionals, and dietitians and nutritionists in particular, typically use to assess what is wrong with their patients, and how they develop treatment plans to help them.

MyPlate - This site provides information on the MyPlate Program, which was designed by the U.S. Dept. of Agriculture to promote healthy nutrition in children over two years of age. It serves as a general guide to daily food choices and includes age-specific food plans, calorie counters, and general nutrition guidelines.

Background Information

The American Dietetic Association - This is the site for the nation's largest organization of food and nutrition professionals.

The American Society for Nutrition - This is the site for The American Society for Nutrition, a premier research society dedicated to improving the quality of life through the science of nutrition.

U.S. Department of Agriculture: Food and Nutrition - Under the U.S. Department of Agriculture's web site, this page gives you general useful information on food and nutrition.

U.S. Department of Agriculture: Dietary Guidelines for Americans - Under the U.S. Department of Agriculture's web site, this page provides guidelines regarding how good dietary habits can promote health and reduce risk for major chronic diseases.

Nutritional Needs of Adolescents - This article provides a detailed account of facts and statistics regarding the nutritional needs of adolescents.

The Science of Biology, Eighth Edition, William K. Purves - This link requires a username and password. Your username is vista1, and your password is arginine. Using the menu at the top of the screen, select Chapter 50 (on nutrition) for the most relevant material.