Part I, Criteria #1: Excess Fat & Carbs
Patient J.W is eating an excess number of calories, fat, and carbs in his diet. J.W has been eating fast-food three meals per day. According to US National Library of Medicine National Institutes of Health Prospectively, “Greater weight gain is observed among frequent fast-food consumers compared with less frequent fast-food consumers. Fast-food intake has been shown to be associated with BMI and excess weight gain (Barnes et al., 2016).” Consuming the amount of fats that J.W has been will be detrimental for his health. J.W has been diagnosed with hypertension and diabetes types II. Hypertension is developed by being overweight, excess salt in diet, and not enough exercise. Also, J.W could have developed type II diabetes with being overweight.
Part I, Criteria # 2: RDA Analysis
The Recommended Daily Allowances is the average daily dietary intake level sufficient to meet the nutrient requirement of 97% to 98% of healthy individuals in a particular life stage and gender group (Dudek, 2014). J.W does not meet the RDA because he consumes fast food every day which is deficient in protein, dietary fiber, vitamin A, vitamin C, calcium, and iron. Fast food is typically high in sugar, salt, and saturated or trans fats. Many fast food meals are very low in fiber (Huzar, 2019). Depending on what kind of meals J.W consumes, most fast food meals do not have the appropriate amount of protein, dietary fiber, vitamin A, vitamin C, calcium, and iron.
Part II, Criteria #1 Diet and Pathophysiology
J.W has hypertension and diabetes type II. Hypertension is a common condition in which the long-term force of the blood against your artery walls is high enough that it may eventually cause health problems, such as heart disease (‘High blood pressure (hypertension)’, 2018). A person who consumes too much sodium in their diet is at risk for high blood pressure. J.W eats more than enough fast food that contains high amounts of sodium. For example, one McDonalds big mac contains 950 mg of sodium (‘McDonald’s Cheeseburger Nutrition Facts’, n.d). One order of medium fries from McDonalds has 230 mg of sodium in it (‘McDonald’s Cheeseburger Nutrition Facts’, n.d). To complete the meal, if J.W ordered a large Dr. Pepper that itself contains 95 mg of sodium (‘McDonald’s Cheeseburger Nutrition Facts’, n.d). In total, one combo contains 1,275 mg of sodium. According to the American Heart Association, “The recommendation of sodium no more than 2,300 milligrams (mg) a day and moving toward an ideal limit of no more than 1,500 mg per day for most adults (‘How much sodium should I eat per day?’, 2018).” J.W is eating out three times a day so this number would be multiplied by three. On average, J.W is consuming 3,825 mg of sodium per day. This is exceeding the limit by far numbers and contributes to his hypertension.
J.W also has diabetes type II. Diabetes type II is a chronic condition that affects the way your body metabolizes sugar (glucose), an important source of fuel for your body (‘Type 2 diabetes’, 2019).” This means that J.W must control his sugar levels and make sure they do not drop or spike in levels. J.W is taking metformin to help him control his sugar levels, but he also must abide to a proper diet. Managing his sugar levels will help him control his diabetes.
Part II, Criteria # 2 Medication Interaction
Currently J.W is taking metformin, metoprolol, and a multivitamin. Food may have varying effects on the absorption of metformin from immediate-release versus extended-release formulations. Metformin should be taken with meals, and excessive alcohol intake should be avoided during treatment (‘Metformin and Alcohol / Food Interactions’, 2020).” Grapefruit is a known fruit that can interact with metformin. Some of the chemicals found in grapefruit can bind to and inactivate an enzyme in your body that’s found in your intestines and liver. This enzyme helps break down the medication you take (Seladi-Schulman, 2018). While J.W is taking metoprolol, he should take metoprolol at the same time each day, preferably with or immediately following meals. This will make it easier for his body to absorb the medication (‘Metoprolol and Alcohol / Food Interactions’, 2020). As for J.W taking a multivitamin, there has not been found evidence leading to any interactions with food.
Part III, Criteria #1 Calculations
Our patient is a 60-year-old male who is 6’0′ (72 inches) and 230 pounds (104.5 kg). BMI Using this calculation, the patient’s BMI is 31.2 and according to the CDC, the patient’s BMI is obese, which ranged from 30.0 and above is obese weight (‘Adult BMI Calculator’, 2020).
BMR
The patient’s BMI falls under the Obese Weight category. One imprecise, rule-of-thumb guideline for estimating BMR is to multiply healthy weight (in pounds) by 11 for men. For example, a 130-pound woman expends approximately 1300 cal/day on BMR (130 lb 10 cal/lb 1300 calories) (Dudek, 2014). J.W would be 230 pounds multiplied by 11, which would result in 2,530 calories. Part two would include estimated total calories according to usual activity level; Choose the category that describes your usual activities and then multiply BMR by the appropriate percentage. Sedentary: mostly sitting, driving, sleeping, standing, reading, typing, and other low-intensity activities (20) (Dudek, 2014). Part three would entail adding BMR calories and physical activity calories____(20)___ calories for BMR ___(2,530)_____ calories = spent on activity __(2,550)______ calories spent on involuntary and physical activity.
CHO
For example, a person who eats approximately 2,000 calories per day should take in about 250 grams of carbohydrates (2,000 divided by 2 = 1,000 and 1,000 divided by 4 = 250). J.W should eat 2,530 calories divided by 2 = 1,265 divided by 4 = 316 grams per day (Lehman, 2020).
PRO
According to The Centers for Disease Control and Prevention (CDC), J.W is recommended 55 – 194 grams/day (10-35% of daily caloric intake) using a protein calculator based off of height, weight, and daily exercise (‘Protein Calculator’, n.d).
FAT
According to The Centers for Disease Control and Prevention (CDC), J.W is recommended 52 – 90 grams using a fat calculator based off height, weight, and daily exercise (‘Fat Calculator’, n.d).
Part III, Criterion #2 SMART Goals and Patient Care Plan
My recommendation for J.W would be to get on the DASH diet. DASH stands for Dietary Approaches to Stop Hypertension. The DASH diet encourages you to reduce the sodium in your diet and eat a variety of foods rich in nutrients that help lower blood pressure, such as potassium, calcium and magnesium (‘How to make the DASH diet work for you’, 2019). This will help J.W control his hypertension.
Smart goal number one would be to incorporate exercise into his daily life. Since J.W does not exercise, I would like him to walk with his children 3x a week for 30 mins a day. Eventually J.W can expand this and walk every day for an hour.
Smart goal number two would be to start eating within his calorie range. This would mean to cut back and then ultimately cut off fast food. J.W eats 3x a day every day. I would recommend J.W limit fast food to once or twice a week starting the first month. After the first month I would like J.W to only eat out maybe once a month or not at all.
Smart goal number three would be to incorporate meal prepping into his life. Being able to meal prep the night before work can help J.W cut back on eating out. This can also help J.W lose weight and be overall healthier.
