Case study: nutrition and weight loss

1. Case study: nutrition and weight loss By Millie Patchan

2. Demographics • Male • Employment: Veterinarian • Education: Doctoral degree • 6'3  • 290lbs • 29 years old  • BP: 136/78 • HR: 74bpm • BMI: 36.2 • Body Fat %: 27.40% • Food Frequency Questionnaire (FFQ) • Readiness for Change Questionnaire (RCQ)

3. Health behavior • Health behavior: To improve nutritional habits in order to decrease body weight  • History of behavior:  • Weight gain started in 2007 when he started college • Continued to slowly gain weight over time due to poor eating habits and lack of physical activity • Attempted to lose weight from February-April 2017 with healthy eating, but has gained most of the weight back • Eats poorly when busy and stressed  • During this case study he was building house, moving, & sister was getting married

4. Overview of Stages of change model • 5 stages • Helpful with nutritional changes1 • When model used =fat intake & fruits & veggie intake2 • Strengths • Allows better understanding of an individual’s behavior3 • Weaknesses • Does not show long-term effects from interventions4

5. Preparation stage • Individual entered at preparation stage • General idea of how to eat healthy • Wanted to get back on track within the next month • Readiness for change questionnaire5 • Scored 26 WANTS TO MAKE A CHANGE!! YAY! • Food Frequency Questionnaire6 • Detects dietary intake and eating habits

6. Plan of action • Tracked servings of fruits, vegetables, grains, protein, dairy, sugar, and water consumed daily for 4 weeks using a food log • Education • benefits of good eating habits on weight loss, and decreasing blood pressure • Spouse support/spouse education • Set small weekly goals that are attainable

8. Weekly Meetings/Interventions7,8,9,10 • Week 1: collected demographics and outcome measures, provided information on healthy eating, discussed goals, instructed them in using food tracker sheet, provided servings reference guide • Week 2: reviewed weekly goal, reviewed how to record daily food intake, education on packing a healthy lunch • Week 3: reviewed weekly goal, educated on spousal support, provided article on spousal support • Week 4: Reviewed weekly goal, discussed how spouse was integrated into healthy eating plan, provided information on diet and high blood pressure • Week 5: Re-measured outcomes, final instructions

9. Goals • Week 1: Properly record food eaten 7/7 days that week • Week 2: Pack lunch 4/7 days per week, incorporate 1 servings of vegetables and 1 servings of fruit 4/7 days per week  • Week 3: Pack lunch 5/7 days per week, drink 8 8oz glasses of water 5/7 days per week, and incorporate 2 servings of vegetables 5/7 days per week • Week 4: Continue all goals from week 3 and incorporate 2 servings of fruit 5/7 days per week  • Week 5: Final instructions

10. Long Term Goals • To lose weight and maintain weight loss • To increase awareness of eating habits • To increase knowledge of healthy eating and its benefits

11. Final Instructions • Continue to consume 8-10 glasses of water daily • Consume >/=2 servings of fruits and vegetables daily 5/7 days • Continue to encourage spouse and yourself to eat healthy together • Schedule check up at doctor due to consistent high BP • Participate in physical activity >/=3 times per week for 30 minutes (once schedule permits)

12. Outcomes Pre-Intervention Post-Intervention 288lbs BP: 138/76 HR: 72 bpm BMI: 36.0 Body Fat %: 26.7% FFQ= greater amounts of vegetables, fruits, whole grains, and dairy RCQ= 32 • 290lbs • BP: 136/78 • HR: 74 bpm • BMI: 36.2 • Body Fat %: 27.4% • FFQ= greater amounts of processed grains, sugar, and protein • RCQ= 26

13. Outcomes • Effectiveness of interventions • Semi-effective as noted by outcomes, but not as successful as I would have liked • did not stress enough on how to cope with stress related events and eating • How would you modify the case? • Implement more interventions on stress and eating • Administer all information at the same time to increase effectiveness of intervention for given time frame • Future PT practice • Not to be afraid to talk to patients about this topic • PT is shifting into this mind set of prevention, health and wellness • If anything, educate

14. Questions?

15. references • 1.Horwath C, Schembre S, Motl R, Dishman R, Nigg C. Does the Transtheoretical Model of Behavior Change Provide a Useful Basis for Interventions to Promote Fruit and Vegetable Consumption?. American Journal Of Health Promotion [serial online]. July 2013;27(6):351-357. Available from: SPORTDiscus with Full Text, Ipswich, MA. Accessed July 15, 2017. • 2. BedeschiL, Santos L, Souza Lopes A, et al. Interventions directed at eating habits and physical activity using the Transtheoretical Model: a systematic review. NutricionHospitalaria [serial online]. September 2016;33(5):1194-1204. Available from: Food Science Source, Ipswich, MA. Accessed July 15, 2017. • 3.Horwath C, Schembre S, Motl R, Dishman R, Nigg C. Does the Transtheoretical Model of Behavior Change Provide a Useful Basis for Interventions to Promote Fruit and Vegetable Consumption?. American Journal Of Health Promotion [serial online]. July 2013;27(6):351-357. Available from: SPORTDiscus with Full Text, Ipswich, MA. Accessed July 17, 2017. • 4. Brug J. The Transtheoretical Model and stages of change: a critique: Observations by five Commentators on the paper by Adams, J. and White, M. (2004) Why don't stage-based activity promotion interventions work?. Health Education Research. 2004;20(2):244-258. doi:10.1093/her/cyh005. • 5. Enhancing Motivation For Change In Substance Abuse Treatment. [Electronic Resource] [e-book]. Rockville, MD : U.S. Department. of Health and Human Services, Substance Abuse and Mental Health Services Administration, Center for Substance Abuse Treatment, [2012]; 2012. Available from: OhioLINK Library Catalog – LR, Ipswich, MA. • 6. Marventano S, Mistretta A, Platania A, Galvano F, Grosso G. Reliability and relative validity of a food frequency questionnaire for Italian adults living in Sicily, Southern Italy. International Journal Of Food Sciences & Nutrition [serial online]. November 2016;67(7):857-864. Available from: SPORTDiscus with Full Text, Ipswich, MA. Accessed July 16, 2017. • 7. Khezeli M, Ramezankhani A, Bakhtiyari M. Effect of Education on Nutritional Knowledge and Stages of Fruit and Vegetable Intake in Geriatrics According to Stages of Change Model. Journal Of Mazandaran University Of Medical Sciences (JMUMS) [serial online]. August 2012;22(91):87-98. Available from: Academic Search Complete, Ipswich, MA. Accessed July 17, 2017. • 8. Gallagher P, Yancy W, Voils C, et al. Patient self-efficacy and spouse perception of spousal support are associated with lower patient weight: Baseline results from a spousal support behavioral intervention. Psychology, Health & Medicine [serial online]. March 2013;18(2):175-181. Available from: SPORTDiscus with Full Text, Ipswich, MA. Accessed July 17, 2017. • 9. Ndanuko R, Tapsell L, Charlton K, Neale E, Batterham M. Associations between Dietary Patterns and Blood Pressure in a Clinical Sample of Overweight Adults. Journal Of The Academy Of Nutrition & Dietetics [serial online]. February 2017;117(2):228-239. Available from: CINAHL Plus with Full Text, Ipswich, MA. Accessed July 17, 2017. • 10. Ndanuko R, Tapsell L, Charlton K, Neale E, Batterham M. Dietary Patterns and Blood Pressure in Adults: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Advances In Nutrition [serial online]. January 2016;7(1):76-89. Available from: CINAHL Plus with Full Text, Ipswich, MA. Accessed July 18, 2017.