Question

Melanie just turned 40 years old. She’s lived an active life. In high school, she participated in many sports, including basketball and track and field. During her senior year of high school, she was recruited by a prestigious college to play basketball and she received a full scholarship for all 4 years. Since college, Melanie has worked hard to maintain an active lifestyle and visits her local gym at least three times per week. She currently lifts weights and often runs on a treadmill.  

Melanie has always had a voracious appetite and has been able to eat anything she pleases without worrying about weight gain. During a recent doctor’s appointment, her doctor expressed concerns about her weight. Throughout college, Melanie, who is 5 feet 11 inches tall, weighed in at a muscular 175 pounds. Now she weighs 200 pounds. As a result, Melanie has cut out the two donuts she ate for breakfast and reduced her portions. She complains of feeling hungry after she eats. She still eats fast food for lunch 2-3 days per week and enjoys going out with friends for coffee or a couple beers depending on when they choose to go. Below is Melanie’s diet recall:  

Breakfast: Oatmeal with 2 T brown sugar, 12 ounces of orange juice, 2 slices of whole wheat toast with 1 T butter.  Coffee with cream & sugar

Lunch: Sandwich with turkey, cheddar cheese, mayonnaise, mustard, and tomato on whole wheat bread, 1 small bag of potato chips, and 12 oz. of regular soda.  

Dinner: 6 ounces of baked chicken, 1 cup of mashed potatoes made with milk and butter, 1 cup of corn, and 8 ounces of 2% milk.  

Evening Snack: carrots with 2 T ranch dressing

Melanie’s sister has osteoporosis and her physician has recommended a DXA scan.

1. Prepare an assessment using the 4 domains (exclude Nutrition Focused Physical Assessment since we have no data).
2. What additional information do you need to make an accurate diagnosis?
3. What factors do you think are contributing to Melanie’s weight gain?
4. What conditions may Melanie be at risk for?
5. Melanie is in what stage of bone development? What lifestyle factors do you think may
6. contribute (either positively or negatively) to the results of Melanie’s DXA scan?
7. What positive changes has Melanie made in her diet?  
8. How might Melanie’s weight loss efforts affect the adequacy of her nutrition?
9. Why might Melanie have a difficult time losing weight?
10. On the basis of her diet recall, list four suggestions you have for Melanie to help her improve her diet.  
11. What can Melanie do additionally to prevent further weight gain and to help keep her healthy for years to come?
12. Melanie is considering a weight loss supplement she heard about called Skinny Gal Weight Loss for Women (yes, it does exist). What information would you share with her about this product? What, if any, supplements would you suggest that she consider?

Answer 1

#. Additional information required is measure of bone mineral density (BMD). It is most commonly performed using dual-energy x-ray absorptiometry (DXA or DEXA) or bone densitometry.

#. Factor contributing to her increased weight :-

Food habits

Hereditary

#. She would be at risk for fracture .

As per age, she is in the bone development stage in which bone begins to lose bone mass.

The lifestyle factors that contribute(either positively or negatively) to the results of Melanie’s DXA scan is her activeness in sports .

#. The positive changes to be made in her diet are :-

Include Dairy products: milk, yogurt, cheese and calcium-fortified cottage cheese. Green leafy vegetables: broccoli, kale, collard greens, dried figs, turnip greens, and mustard greens. Fish: canned salmon and sardines with the bones. Nuts: almonds and Brazil nuts.

Diet low in Salt

Include enough calcium and vitamin D

Avoid caffeine and carbonated drinks