How to Critique the Nutritional Plan: 

Given your assessment of Jay Carter’s needs and risks in Task 1.2: Assessing the Client’s Needs and Risks (which should have taken into consideration his interview, Diet & Exercise Journal, and his answers on his Customer Satisfaction Survey), you can now critique Michael Wilson’s nutritional plan to determine whether it was a good fit for Jay. Use the Nutritional Plan Critique Template provided to record your work.

Remember as you work on Task 1 with your teammates, you should allocate some time to working independently on the “On Your Own” tasks.

Get Organized

1. Meet with your team. Remember to start by asking yourselves what exactly you have been asked to do. Re-read the email from Pat Niren and review the attached Nutritional Plan Critique Template which includes the elements of the plan you need to critique. Note that you should provide scientific evidence when possible.
   
   
2. Refer to the relevant support materials, including the Practitioner’s Nutritional Plan, from Pat’s earlier email in Task 1.1: Critiquing the Practitioner’s Interview.
   
   
3. Identify one person to be a team leader. Discuss with your team how you want to tackle this work and make a concrete plan.

Conduct Your Critique

1. Create a list of questions you think Michael Wilson should have asked Jay. As you conduct your critique, if you think Michael Wilson should have asked Jay additional questions during the client interview, write them down (create a list in rough bulleted format or revise your earlier list if you started one in Task 1.2: Assessing the Client’s Needs and Risks). Submit your list to your mentor as a deliverable when you complete this task. If you choose to submit this list of questions, you have the option of revising and resubmitting your Client History Critique Template from Task 1.1: Critiquing the Practitioner’s Interview for reconsideration by the mentor. Revising this document may help you better understand what worked (or did not work) well in the client interview and, as a result, better prepare your critique of the practitioner's nutritional plan.
   
   Note: this list of questions may also be helpful to you in the task On Your Own A as you consider questions that you think should go into a client-assessment questionnaire.
   
   
2. Compare Wilson’s nutritional plan to your earlier assessment of Jay’s needs and risks (Task 1.2: Assessing the Client’s Needs and Risks). Use the Nutritional Plan Critique Template to evaluate the positive aspects of Michael Wilson’s plan and note any specific areas for improvement. Refer to the Resources (link above) to help you complete your critique. In particular, you may find it helpful to refer to the Overview of Eating Disorders. You may wish to first take notes using the template or a separate document before you then draft the version you plan to submit.
   
   

NUTRITIONAL PLAN CRITIQUE TEMPLATE

The following steps parallel the template, but may be completed in any order as you conduct your critique.

1. Critique the general guidelines section of Michael Wilson's nutritional plan for Jay Carter. These are key concepts that Wilson chose to highlight as part of his overall nutritional recommendations for Jay.
   
   Consider the following questions as you assess Wilson’s general guidelines:
   
   
   • How do Wilson’s guidelines compare with the client’s needs and risks you identified earlier?
     
     
   • What are the positive aspects of his guidelines?
     
     
   • Consider the needs and risks that you identified that Wilson may have overlooked. How might he have improved his guidelines for Jay Carter? Include any ideas you have about possible treatments, as appropriate.
     
     
   • Is there something Wilson is recommending that you don’t think will work?
     
     Remember to justify your conclusions and provide scientific evidence to support yourself whenever possible.

2. Critique Michael Wilson’s recommended meal plan for Jay Carter. Using the template, record the positive aspects of the plan, as well as the areas where requiring improvement.
   
   Consider the following questions as you assess Wilson’s meal plan:
   
   
   • How well does the plan compare with Jay’s needs and risks you identified earlier? (You may review relevant aspects of your earlier assessment of Jay’s eating situation such as his caloric needs, eating habits, goals and concerns, etc.)
     
     
   • What are the positive aspects of Wilson’s meal plan for Jay?
     
     
   • Consider the needs and risks that you identified earlier that Wilson may have overlooked in his meal plan for Jay. How could he have improved his plan? What are its weaknesses, if any?
     
     
   • Is the plan something Jay can live with? Was it tailored to his needs?
     
     
   • Is the plan likely to help Jay succeed in achieving his goals while keeping him healthy?
     
     
   • Is there something Wilson is recommending that you don’t think will work? (If so, be sure to explain why you think so, biochemically speaking).
     
     
   • Did Jay follow the meal plan? If not, what might have been problematic with the recommended plan? Refer to the Customer Satisfaction Survey from Task 1.1: Critiquing the Practitioner’s Interview, as needed.
     
     
3. Critique Michael Wilson's rationale for the nutritional plan. The rationale reflects Wilson’s reasoning for the guidelines and meal plan he came up with for Jay. As you conduct your critique, identify the positive and negative aspects of Wilson's approach, keeping in mind your own rationale from your earlier assessment of Jay's needs and risks.
   
   
   • How well does Wilson’s rationale reflect a good understanding of Jay’s needs and risks? What are strengths and weaknesses in his reasoning?
     
     
   • How well does his rationale indicate a solid grounding in the area of nutrition?
     
     
   • How well does his rationale align with Jay’s goals? Note any gaps in the Wilson’s reasoning.
     
     
4. Review Wilson’s explanation he provided during the client consultation (which took place after the video interview). Assess whether he adequately educated Jay about key aspects of the nutrition plan. To determine this, ask yourself the following questions:
   
   
   • Did Wilson explain his rationale behind the nutritional plan, especially for aspects of the plan that do not align with Jay’s goals or lifestyle, or those that require significant shifts in Jay’s current patterns related to nutrition?
     
     
   • Did Wilson’s explanation enable Jay to adjust his expectations and behaviors to be healthier?
     
     
   • Revisit Jay’s responses to the Customer Satisfaction Survey. How does his feedback reflect Wilson’s success or failure to sufficiently educate Jay about key aspects of the nutritional plan (e.g., significant behavioral changes, etc.)?
     
     
5. Critique Wilson’s notes about whether Jay needs a referral. Did he accurately assess whether a referral to a specialist was necessary? To determine this, ask yourself the following question:
   
   
   • Are all of Jay’s issues nutritionally related or may some indicate psychological issues or other health conditions that fall outside Michael Wilson’s area of expertise as a nutritionist?
     
     Review the Resources link (above) for helpful information on referrals, and critique Michael Wilson’s handling of referrals.
     
     
6. Critique Wilson’s assessment of the client’s needs and risks that are addressed in the plan. How well did Wilson capture Jay’s nutritional needs and risks and how sufficiently does the plan address them? Refer to your earlier analysis of Jay’s needs and risks and compare them to those that Wilson identified.
   
   
7. Assess whether Michael Wilson accurately noted any risky behavior patterns that should be monitored during Jay’s next visit. To determine this, review your earlier assessment of Jay’s needs and risks and ask yourself the following question:
   
   
   • What, if any, potentially dangerous behaviors is Jay demonstrating that could threaten his health? Consider restrictive behaviors (e.g., under-eating) and extreme behaviors (e.g., over-eating, abuse of medications).
     
     Include your rationale and evidence as appropriate.

Write Your Critique

1. Write your formal assessment of Michael Wilson’s nutritional plan for Jay. Convene your team and discuss your research and findings. Use the notes you took in your answers to the questions above and work together to synthesize your findings into one comprehensive report in the Nutritional Plan Critique Template.
   
   
2. Summarize your critique of Michael Wilson’s nutritional plan at the end of the Nutritional Plan Critique Template. The final section of the template asks you to provide a summary of your critique so Michael Wilson can get the big picture of what he’s doing well and where he needs improvement. Use as much space as necessary to organize your ideas in a clear way and provide a thorough summary (i.e., do not limit yourself to the space on the template).
   
   

Submit Your Work

1. Review your work with your teammates and make sure everyone has signed-off on the report before the group leader submits it for review.
   
   
2. Submit your Nutritional Plan Critique Template to your mentor for review. Check the Submit your work section of this task to determine how to name and send your documents. You may also submit your list of questions you think Michael Wilson should have asked and your Client History Critique Template if you chose to revise it.

Educating the Client

• A practitioner should help his/her client “buy into” the nutritional plan and believe that it is worth following. It’s not enough to just give a client a nutrition plan and hope they follow it. To increase the likelihood that the client will follow the plan, a practitioner should explain the reasoning behind the nutrition plan in a way that s/he will find convincing and motivating.



• A nutritional advisor should educate the client about ways to make healthy choices his/her diet and exercise and teach him/her to be self sufficient. This helps increase the odds that the client will follow the plan over the long-term.



• Consider whether the practitioner has assessed the client’s understanding of his/ her nutritional needs and risks and tried to educate him/her appropriately to ensure he/she understands how the plan addresses them.

Providing Appropriate Rationale

• A practitioner’s rationale for the nutrition plan should include research or scientific evidence to support his/her recommendations as opposed to hearsay or reference to fads or no evidence at all.

Considering Client Lifestyle

• A practitioner should consider the client’s routines (e.g., eating out occasionally with family) when creating a diet plan and offer flexibility that accommodates his/ her lifestyle while still promoting healthy behaviors.



• A practitioner might be tempted to tell a client what they “should” and “should not” eat.  Some practitioners are overly rigid when providing clients with guidelines to follow.   It’s better to give clients guidelines that are somewhat flexible so they can adapt healthier choices to their lifestyle and routine. This offers a more realistic approach for clients.



• A nutritional advisor should consider a client’s likes and dislikes when creating a meal plan. Including foods a client does not like and overlooking foods s/he does like significantly decreases the likelihood of the client following the plan on a long-term basis.



• A practitioner should not overlook a client’s need for variety in the foods s/he eats.  A good diet plan is both well-balanced (i.e., representing an appropriate range of foods from the Food Guide Pyramid) and a wide selection of foods.  Variety is good from a nutritional standpoint and keeps a client from getting tired of eating the “same old foods.”
  
  

Assessing Client Readiness

• A practitioner should consider whether the nutritional plan factors in the client's readiness to change certain behaviors related to his/her nutritional health. If the client seems unwilling to make the necessary changes, the nutritional advisor should acknowledge that and recommend against changes until the client is sufficiently motivated.

Monitoring Client Progress

• A practitioner should keep in mind that a client’s nutritional well-being evolves over time. It is good practice to monitor a client’s progression toward nutritional health over time. Noting specific concerns or behaviors to look out for on a client’s nutritional plan is also a good idea.

Knowing When to Make a Referral

• A nutritional advisor might think that s/he can handle any problem the client presents. It is important to recognize that sometimes clients have issues that fall outside the realm of a nutritional advisor’s area of expertise. When that is the case, a dietitian should make a referral to a professional with the appropriate area of expertise (e.g., a medical doctor or a psychologist).

Overview of Eating Disorders - This overview gives you information on how to identify, assess, and treat eating disorders. The content provided in the overview links to useful web sites that provide additional, relevant information on clinical findings, risk factors and treatment options.

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?

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

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.

Nutrient Deficiencies - In most of America, vitamin deficiencies are rarely seen. This FAQ explains how nutrient deficiencies are treated.

Creating Nutritional Plans - A nutritional plan must fit with the client’s lifestyle to ensure that it is something he or she can realistically follow. This FAQ explains the elements that go into a good nutritional plan.

Educating Clients about their Nutritional Health - This FAQ explains how a dietitian can educate the public on nutritional and dietary issues.

Nutritional Considerations for Athletes

Overview of Nutrition Needs for Athletes – This page from Colorado State University provides general nutrition information for athletes, along with some sample menus for healthy food options.

Nutritional Education for Wrestling Coaches – This presentation from the Michigan High School Athletic Association provides guidelines on healthy nutritional choices for wrestlers.

Eating Before Competing - This page gives tips on good foods that athletes can eat before a competition.

Making Referrals

Referring a Client to Another Health Professional - This FAQ explains how a dietitian or nutritionist can determine when he or she is not qualified to provide care and must make a referral.

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.

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.