Initials: SA

51 YOWM
Interviews via phone

Introduction

SA is a 50-year old male who has a history of high blood pressure and has recently found

out he has high cholesterol levels. He is mostly concerned with his high blood pressure, high

cholesterol levels, and physical inactivity. SA said that he would like to improve his activity level,

blood pressure, and cholesterol levels and learn to manage his weight, lower his sodium intake, and

increase his intake of fruits and vegetables.

Assessment

SA works out of his home in sales for an adhesive tape company. His work involves long

hours on the phone and sitting at a desk for most of the day. SA lives with his wife and two of his

children. His wife grocery shops for the family and prepares his lunches and dinners. He is

interested in healthy eating, has good self-control when eating, doesnt snack a lot, doesnt think

about food very often, and never eats out of boredom. He likes to cook, has a decent knowledge of

nutrition, and really enjoys salads and oatmeal.

Seven years ago, SA got his right kidney and gallbladder removed due to cancer and

multiple kidney stones and gallstones. Because of this, he has to carefully watch his diet and make

sure he isnt consuming too much sodium. He sometimes has problems with indigestion and

occasional diarrhea. SA has also gained 10 pounds within the past two years. SA takes high blood-

pressure medication, a multivitamin, Coenzyme Q10 (CoQ10), Florastor probiotics, and flaxseed

oil, vitamin D and C, celery seed, and omega-3 supplements.

SA does enjoy physical activity, including hiking and biking. About ten years ago, he used

to bike about 3 times a week with friends. He enjoys being active with his family in order to make

working out more enjoyable. Due to busy work hours, working out of the home, high stress levels,

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 and limited time and energy, his physical activity is fairly low. His activity mostly consists of

walking around his home, up and down the stairs, while talking on the phone with clients.

Important Confident Ready

Readiness to Change 10 8 7
Motivation for change= 7

Anthropometrics:

Wt: 198#
Ht: 73in
BMI: 26.19 kg/m^2 (High; overweight)
Waist circumference: 36in (high risk)
IBW: 184#, %IBW: 108%
UBW (2 years ago): 185#, %UBW: 107%
%wt change: 11%
BP: 138/98 mm Hg

Clients BMI and waist circumference is too high, indicating he is overweight. High BMI

and waist circumference may be causing his hypertension and high LDL cholesterol, and are

related to low physical activity.

Dietary Assessment:

EER: 2350 kcals (1.3 activity factor)

24 hr recall kcals: 1800 kcals

Concerning his intake, I used both the food frequency questionnaire and 24-hr recall. It

seems like he only eats fruits and vegetables in a smoothie every morning, but no other time during

the day. Client should improve the variety of vegetables he consumes throughout the day. It would

be beneficial to evenly spread out his fruit and vegetable intake throughout the day for maximum

absorption and benefits. For the 24-hr recall, many of his food choices were high in sodium and fat,

including ham, prosciutto, salami, and Italian dressing. For the food frequency questionnaire, he

doesnt seem to consume enough whole grains, vegetables, or healthy fats. On the other hand, he

tries to only eat lean meat and mostly avoid sweets and alcohol.

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 Client follows a low-sodium and low-fat diet for high BP and cholesterol. In general, he

doesnt like to eat high-fat food. He eats out about four times a week, usually to buy a sandwich for

lunch or go to dinner with his wife. Client eats at regular times of the day (3 meals/day). He rarely

snacks in between meals because is busy and distracted with work. He particularly likes salads,

oatmeal, eggs, sushi and Mexican, Italian, Indian, Vietnamese cuisine. SA said that he would like

to improve his eating habits, learn to manage his weight, lower sodium intake, and increase intake

of fruits and vegetables. Because he has one kidney, he needs to watch his sodium and fat intake to

keep his blood pressure in a healthy range.

Diagnosis

SA has high blood pressure and cholesterol related to high sodium food choices

(specifically deli meat choices), physical inactivity due to sedentary job, and having one kidney as

evidenced by biochemical labs and 24 hour recall showing high sodium deli meat intake and low

consumption of fruit and vegetables. According to the CDC, normal blood pressure is less than

120/80 mmHg, and SAs is 138/98 mmHg, which is high. Clients BMI is 26.19 kg/m^2, and a

healthy range is 18.5-25.9. Two years ago, his BMI was 24.5 kg/m^2. Looking at his 24-hour

recall, his caloric intake was less than the EER. SA said that the 24-hour recall was a typical day

for him, which means that he usually consumes less than the EER. His 10-pound weight gain

within the past two years may be due to a physical activity and a slow metabolism. Because SA

takes multiple medications and supplements, we discussed drug/supplement/nutrient interactions.

When he takes his high blood pressure medication (1x/day), he should avoid grapefruit, chocolate,

processed meats.

Intervention/Monitoring/Evaluation

During the first session, I reviewed food group serving sizes, portion sizes, low sodium

food choices, physical activity readiness, risks of low physical activity, physical activity options,

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and his confidence levels. I encouraged him to eat more fruits and vegetables throughout the day,

and to choose meats that are lower in sodium. I also encouraged him to track his physical activity,

choose lower-sodium foods, and fill out the LMF 8.2 Physical Activity Log every day. The first

goal we came up with for him was to exercise three times a week for 40 minutes each time. I asked

him what kind of physical activities he prefers, and I also gave him exercise ideas. He said he

prefers to walk the hill in his neighborhood, which he said is really steep. I gave him ideas like

doing arm curls with canned foods while he walks around the house on the phone with clients and

to walk around his neighborhood after lunch each day.

I educated SA on the consumption of vegetables, including different kinds of vegetables,

cooking methods to make them taste good, and portion sizes. I also educated him on low sodium

options in order to help him manage a low-sodium diet and to help lower blood pressure. I taught

him how to read nutrition labels and assess whether the sodium content is high or low. I asked SA

if he could do a one-week record of the times he ate sandwiches and which meats he chose, and

whether it was high or low sodium to test his knowledge. This record was also for me to get a

better idea of how often he eats sandwiches and what types of deli meat he normally chooses.

The first set of goals:

1. Within one week, increase vegetable consumption to 4 cups per day.

2. Increase consumption of low-sodium deli meats (450mg or less/2oz serving) for
a low sodium diet that includes 1,500mg or less per day.
3. Client will exercise for 45 min, 3x/week.
4. Weight loss of 2 pounds in 4 weeks on a 2200kcal (26kcal/kg) diet that provides 88g
protein (.97g/kg, 16% kcals), 294 g carbohydrate (53%kcals), and 76 g fat (31% kcals).
a. Long-term goal: get to IBW of 184 pounds in 10 months in order to have a healthier
BMI.
SA put effort into accomplishing each of the four goals we agreed on together. Along with

the green smoothies that he has every morning, he snacked on carrots, cucumbers, and bell peppers

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before and after lunch. He said that while hes working during the day, he sometimes forgets to eat,

so its a challenge for him to take a quick break and prepare a healthy snack. SA mentioned that he

realized cucumbers, carrots, and bell peppers were quick and easy to prepare as a snack, and this

made him more motivated to eat vegetables between meals. Because he usually doesnt prepare his

own meals for lunch and dinner, he talked to his wife about the idea of adding more vegetables to

meals, either as a side dish or mixed in with the meal. She liked the idea and wants to help him

reach his goals, so she has intentionally been adding more vegetables to the meals she has prepared

during these past four days.

SA said that choosing low sodium deli meats has been hard because its a habit for him to

buy the same sandwich at a specific sandwich shop that he eats at 2-3x per week. The sandwich

has salami, ham, and prosciutto and Italian dressing. It is his favorite sandwich, so its going to be

a challenge to choose a sandwich with lower sodium deli products. I suggested that next time he

should ask the employees about their low sodium meat options. He said that when he went grocery

shopping with his wife, he practiced reading the nutrition labels on the lunchmeat packages and

some of the other foods before putting them in the cart. He said some of the deli meats had

packaging that said 45% lower sodium which was very helpful when choosing which meats to

purchase. He said that he only purchased meats that had 450mg sodium or less per serving. He

successfully filled out a weeks worth of deli-meat intake. He ate a sandwich five times; two were

bought at a sandwich shop and the other three were prepared at home. Both times he went to the

sandwich shop he asked the employee if they had any low-sodium meat options, and they had low-

sodium roast beef and turkey. He tried the turkey one time and the roast beef the second time and

said he really enjoyed both.

Concerning his exercise goal, SA walked the hill in his neighborhood one time this past

week. He said he gets too distracted with work and spending time with his family, so its hard to

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make exercise a priority. When we talked about his weight loss goal, he said he hasnt been

focused on the amount of carbs, fats, and protein he consumes each day because he feels like hes

more concerned with his sodium intake and exercise. I realized that having four goals was too

many and difficult to manage, so I focused on just two goals that I believed would be most

important and impactful.

Reevaluated goals

1. A low-sodium diet that includes 2,000 or less of sodium per day, and increase consumption of
low-sodium deli meats and dressings.
2. Client will exercise for 40 min, 3x/week.

Client confessed that he would like to discontinue use of blood pressure medication, and

the low-sodium goal was aimed at assisting with this long-term goal. I encouraged him to prepare

more sandwiches at home and continue purchasing low-sodium deli meats (450mg sodium or

less/2 oz serving) at the grocery store. SA was highly motivated to do this and successfully

prepared sandwiches at home with low-sodium deli meats that his he and his wife purchase at the

grocery store about three times per week. SA said it was hard accomplishing the exercise goal

because he really busy with work, and he didnt feel like exercising after work because he was too

tired. He did, however, exercise twice. I sent him a few 40 min workout videos that he could do in

his room or living room. He tried out one of the videos one time and said he really liked it because

he didnt need any work out equipment for it and it was enjoyable. He also walked the hill in his

neighborhood about once or twice per week, which takes about 40 min. SA said that he would love

to continue working towards accomplishing both of the goals we set for him. He is confident that

he can walk the hill about twice a week, and he said he is going to try to do one of the 40 min at-

home workout videos at least once a week. He is highly motivated because he would love to

improve his blood pressure and cholesterol levels in order to stop taking his blood pressure

medication.