Eating DisordersUnit 6Tamara Hein, MPH, RD, LD, CDE

Adjunct Professor

Counseling

http://www.cartoonistgroup.com/store/add.php?iid=889

Agenda

Patient Centered Interview – video clip

Review of topics from Project 2/unit 5

Discussion of Project 3/Unit 7 SMART GOALS

Eating Disorders – bulimia

Project 2/Unit 5

Weight of client – considerations Should she lose weight?

Project 2/Unit 5 Calculating Nutrients

Josephine

Female – 20 years old.

Weight 117 divided by 2.2 = 53.18 kg

Height: 62” multiplied by 2.54 = 157.48 centimeters

REE Mifflin St Jeor 10 x Wt (kg) + 6.25 x ht(cm) – 5x age – 161

REE = (10 x 53.18) + (6.25 x 157.48) – (5 x 20) – 161 REE = 531.8 + 984.25 – 100 – 161 REE = 1254.05 or 1254 calories Total energy = REE x Activity Factor TEE = 1254 x 1.55 = 1943.77 or 1944 calories. MyPyramid = 2000 calories

Calculating Nutrients - CHO, PRO, FAT

Pick a nutrient standard – Dietary Guidelines for Americans (Mypyramid 50% CHO, 15- 20% PRO, 30-35% FAT)

2000 calories x 50% = 1000 calories divided by 4 calories/gram = 250 grams Carbohydrate.

2000 calories x 15% = 300 calories divided by 4 calories/gram = 75 grams Protein

2000 calories x 35% = 700 calories divided by 9 calories/gram = 78 grams Fat

Percent calories from carbohydrate, protein, and fat should = 100 50 + 15 + 35 = 100

Josephine – 2000 calories/Food Groups

My Pymamid

http://www.mypyramid.gov/professionals/pdf_food_intake.html

Project 3/Unit 7

What specific goals will you establish for this client?

How will you educate the client on what is considered normal exercise and excessive exercise?

How do you motivate the client to remain positive on her changes and not go back to dangerous habits?

Goals and Stage of Change

Goals linked to stage of change

Josephine – Contemplation/Precontemplation – Healthy Weight and reversing malnutrition.

Different goals for different stages.

Smart Goals

SpecificMeasurableAttainableRealisticTimely

Specific Specific goals have a much greater chance of being

accomplished. 6 “W” Questions

1. WHO: Who is involved?

2. WHAT: What do I want to accomplish?

3. WHERE: Identify a location

4. WHEN: Establish a time frame

5. WHICH: Identify requirements and constraints

6. WHY: Specific purpose or benefits of accomplishing the goal

Specific Example General Goal:

“Get in Shape”

Example of a Specific Goal:

Join Anytime fitness and work out 3 days/week. (M, W, F at 7-7:30 AM)

Measurable Establish concrete criteria for

each goal. When you measure progress, you stay on track, reach target dates and experience success.

To determine if a goal is measurable, ask questions such as How much? How Many? How will I know if it is accomplished?

Attainable Identify goals that are

important to you.

Begin to figure out ways to make them come true.

Develop skills, attitudes, financial capability to reach them.

Seek previously, overlooked opportunities

Realistic Must represent a goal you are both willing

and able to work.

You are the only one who can decide how high your goal should be

A high goal can be easier than a low goal. (Low goals – low motivational force)

A hard job can be easy if it is a labor of love

You truly believe it can be accomplished

You have accomplished something similar in the past

Timely Grounded with a time frame

Adds a sense of urgency

Lose 10 pounds in 6 weeks, by August 1

T also stands for Tangible. If you can experience it with your taste, touch, smell, sight, hearing your have a better chance of making it tangible.

Eating DisordersUnit 6

Case Study #1

T.R. is a 15 year old girl present with her mom because her mom thought she was too heavy and kept sneaking in food at night when the mom had put strict rules into place that after 8pm no one was allowed to go into the kitchen. The mom states, “I have tried to lock the doors, but do not feel it is fair to the other kids. She eats breakfast that consists of cereal and milk, but then goes to school and pretends she is poor so she can get another breakfast that is only donuts and milk. Then she refuses to take her lunch to school, so she has all that fried junk. Once she comes home she will eat chips and I work so I cannot keep track of her every move. Then for dinner she will have second helpings. We then all go and watch TV or the kids do their homework, but around 11pm when I am just going to bed I hear someone sneaking around in the kitchen and I just know it is this one right here. She never exercises, my other 2 kids are active in sports, I exercise everyday and so does my husband so I cannot understand why this one can’t do it.” The teenage client sat with her arms folded, not saying a word and had tears in her eyes. She is 5’6” and weighs 170 pounds.

What is her BMI? What would you suggest when you see the client in tears and not speaking?How would you handle the mother?What types of nutrition education would you give them?What goals would you set with the client?Would you follow up with the client?

Case Study #2

K.B. is a 27 year old female present because for 15 years she has been dealing with anorexia and bulimia. She informed you she had been seeing a therapist for over a year and the therapist thought she is now ready to see a nutritionist. She reports she has been eating 6 meals per day, but trying really hard not to count calories. She is stilling have a problem with consuming high fat and sweet foods, will not drink juices or regular sodas and can only do ½ cup of skim milk. She is only walking 30 minutes every day, but doing it outside and not walking that fast. She is taking multivitamins. She will only get weighed with her back turned to the scale and does not want you to tell her the weight, but thinks today she is bloated. Her height is 5’3” and weight is 95 lbs

What is her BMI? What stage of change do you believe she is in?What amount of calories, protein, carbohydrates and fats would you provide to her and would you tell her the amount?What goals would you set with her?Would you follow up with her?

Questions?

Have a great evening!