Term Project Part 4: Counseling

I.
II.

1. Calculating total energy requirements

Height: 5 feet 10 inches = 70 inches
70 X 2.54cm = 178cm (177.8)
Weight: 171 pounds
171 / 2.2 = 78 kg (77.5)
REE for males: 10(w) + 6.25(h) - 5(age) - 161
10(78) + 6.25(178) - 5(26) - 161
780 + 1112.5 - 130 - 161 = 1,602
TEE = REE x AF x IF
1,602 x 1.5 = 2,403
2. Estimated Energy Intakes
Super Tracker 3-Day Average: 2,800 calories a day
Comparison between SuperTracker average and Mifflin St. Jeor equation: The
SuperTracker target calories for my client was just a bit higher than the estimated
energy requirements by using the Mifflin St. Jeor equation by 397 calories. This
could be because of his activity level that was chosen on SuperTracker system.

3. 1 lb Weight Loss Needs

Diet alone: 3500 / 7 days = 500 calories
2403 - 500 = 1,903 kcals/day
With exercise: 2403 + 200 = 2,603
2603 - 500 = 2,103 kcals/day
4. 3 Month Progress
12 pounds lost in a 3 month period putting him at 159 pounds
159/171 x 100 = 93% (normal)
This is a realistic goal for my client. He will be at 93% which is under the 95% range
making it normal weight loss without any risk of malnutrition.
5. Goals and Behavior Objectives
Goal #1: Reduce both overall fat and saturated fat intake
Objective 1: Over the next three months, my client will reduce his dietary fat
intake by reducing his overall fat intake by at least 16% by choosing lean meats and
lower fat options such as fruits and vegetables.
Objective 2: Over the next three months, my client will reduce his saturated fat
intake from 19% to below the suggested 10% by eating less processed foods and
filling up on fresh foods.
Goal # 2: Reducing sodium intake

Objective 1: Over the next three months my client will reduce his sodium intake by
3,118 mg from 5,418 mg a day to the suggested 2,300 mg a day.
Objective 2: Over the next few months, my client will limit processed and high
sodium meats (hotdogs) and snacks to reduce his sodium intake to the suggested
level.
6. Lack of knowledge
1. My client is eating much higher than the Dietary Guidelines of 20-35% of his
calories coming from fat by 16% with his average of 51% over the three day period.
Eating half of his calories coming from fat can put him at risk of heart disease and
stroke if he were to continue eating such a high fat diet for a long period of time.
2. My client is also eating a much higher amount of sodium than the Dietary
Guidelines of 2,300mg of sodium per day. His average over the three day period
was 3,118mg over coming in at 5,418 mg of sodium per day without his additions of
salt on food and hot sauce. Eating a high sodium diet can increase blood pressure,
leading to hypertension, heart disease, and kidney disease. His risk can also be
increased even more due to his below target potassium level.
3. My client would benefit from raising his carbohydrate level specifically whole grains.
He is under the Dietary Guidelines for carbohydrate of 45-65% by 17% (on the low
end) coming in at 28%. Eating more whole grains will give him more energy along
with increasing his fiber intake, which was below target, as well as lowering
cholesterol levels and decreases chances of risk of heart disease and stroke.
7. Inappropriate Eating Behaviors
1. Client is eating a very high sodium diet. To help him reduce his sodium
intake, planning ahead. Preparing meals and snacks ahead of time for the
week will help to stop grabbing things out or vending machine snacks that
are all high in sodium.
2. Client is eating a very high overall fat and saturated fat diet. To help lower
the fat intake in his diet, preparing meals ahead and planning ahead before
going out to eat can help him to choose healthier and lower fat options.
Replacing high fats with lean meats, vegetables and fruits, and whole grains
will improve this area.
3. Client is unaware of his daily intake. Using an app on his phone, such as
MyFitnessPal would make him more aware of the things he is eating and
aiming for hitting goals such as more whole grains, fruits, and vegetables, as
well as watching his sodium and fat intakes. This could also help him to
become more aware of the vitamin intake from food that he is currently
missing in his diet.
8. Dietary Adherence Tools
1. Contracting
Putting together a contract that clearly states the clients goals and lifestyle
changes will help to hold both the client and the counselor accountable. This

contract can also help for the client to see a clear depiction of what they
should be expecting from themselves. This contract can also be helpful for a
reward system as they begin achieving goals.
2. Social support
3. Talking to family/friends about the clients lifestyle changes and asking for the
support will help them to stay on track. Another way to get support is to join groups
such as a yoga class, CrossFit, spinning, etc that the client will meet like-minded
people who enjoy a healthy lifestyle.
4. Positive thoughts
Help a client make an affirmation board or a journal of positive quotes and
encouraging words. Another way to send positive texts or emails to the client
throughout the week so that they know they know you are on their side.
5. Constructive confrontation
If the client is not sticking to the contract or seems to have fallen off track
making sure to empathize with them by listening to their side and then
explain to them why it is important to stick to their plan and work together to
get the client back on track. Being constructive doesnt have to be mean!
9. Peer-Reviewed Journal Article
Frank B, Hu MD, Manson JE, Willett WC. Types of dietary fat and risk of coronary
heart disease: a critical review. J Am Coll Nutr. 2013 Jun; 20(1): 5-19.
This critical reviewed article focuses on how the different types of fat are more
important pertaining to the risk of cardiovascular disease than the overall fat
consumption in the diet.
10. Recommendations for Improvement
Making sure that each section has been explained in class because even though we
all should be looking ahead and working ahead, realistically most people wait until
the last minute and have questions pertaining to the directions and what is
expected for responses.