Monitoring patient progress regarding dietary change is so important as this helps you keep track of successes and failures. This will enable you to modify therapy as necessary in order to maximize positive outcomes for your patient.

Here's another case example…

Brian B. is a 23 year old army corporal who has been told by his company commander that he needs to lose 30 lbs. in order to be considered for a promotion. You have been working with Brian on increasing his physical activity level and cutting down on snacks, beer, and sweets. Brian comes to see you for a follow-up visit and brings this chart.

Monday - worked out with Tony for one hour, went to the bar and had one light beer, no nuts or pretzels Tuesday - went to the basketball court, played 3 rounds of ball, went to the bar and had 2 light beers, no nuts or chips Wednesday - ran 3 laps around the course, tired and fell asleep in front of the tv, woke up and had bowl of ice cream Thursday - worked out again with Tony for 2 hours, ate popcorn and diet soda for snacks Friday - worked out with Tony but pulled hamstring, ate whole bag of chips in front of tv at night Saturday - company party - pigged out on cookies, chips, had 7 beers (not light) no exercise Sunday - hungover, no exercise, slept most of the day, had frozen tv dinner for supper Weight Record: wk 1: 198 wk 2: 198 wk 3: 187 wk 4: 189

Overall, how is Brian doing?

How do you think he feels regarding his progress? What suggestions or advice do you think would be appropriate for Brian at this point? Click on the suggestions you think would be helpful.

 

Join AA, you have a drinking problem.

Yes
No

You're doing well with the exercise, keep up the good work!

Yes
No

Try to keep problem foods like potato chips out of the house.

Yes
No

Don't worry about the days you relapse, just keep going in a positive direction to reach your desired goals.

Yes
No

When we look at your weight record, I see a general slow downward trend - don't be discouraged - your goal is to lose no more than 1 to 2 pounds a week.

Yes
No

We need to step up that weight loss, cut out all the snacks at night.

Yes
No

I think you need to see a dietitian for long-term dietary counseling so you can reach your goal safely and effectively.

Yes
No

 

Just as in other areas in medicine, nutrition is a specialty in itself and no one practitioner can be expected to have all the expertise in all areas of clinical practice. Guidelines for referring patients to qualified nutrition professionals are outlined below:

• Multiple medical conditions requiring multiple dietary interventions
• Type 1 diabetes mellitus
• Type 2 DM-new diagnosis, medication change or HgbA1C >7.0%
• Malnutrition in hospitalized patients
• Cancer treatments such as radiation and chemotherapies
• Gestational Diabetes
• Hypertension
• Eating disorders
• Osteoporosis
• Long term non-adherence of dietary advice/prescriptions
• Obesity (BMI > 30)
• Renal disease

Note: As mentioned previously, physicians are still the providers who patients listen to the most and it cannot be emphasized enough how important it is for you to communicate your concern regarding your patients' nutrition issues. So, whether you counsel patients on nutritional problems yourself or whether you refer them to consultants, your nutrition knowledge, concern, and ability to follow up are paramount.

 

Content questions should be directed to: Marilyn.S.Edwards, Ph.D., R.D.
or Maggie McQuiggan, M.S.
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