Consultations


Clinical Approach For a 1-hour Nutrition Consultation

In the one-hour session, you will complete the following:

  • A general information questionnaire
  • A brief medical assessment
  • Anthropometrical assessment
  • A diet history
  • Discussion of recommendations and advice, printout appropriate information

General Questionnaire

The general information questionnaire will encompass the following areas:

  • Goal setting
  • Lifestyle
    • Family/living situation
    • Eating out
    • Dietary dislikes
    • Alcohol
    • Exercise
    • Current supplementation practices

Medical Assessment

The medical assessment is to make sure that any dietary advice is appropriate for any underlying medical conditions. You may also be able to tailor advice based on a medical situation e.g. A patient with raised blood cholesterol levels should receive the appropriate information sheet (see section on special nutritional considerations).

 This assessment will briefly include:

  • Current Medication
    • What medication are they taking
  • Medical History
    •  Do they have any medical problems e.g. high cholesterol, high blood pressure, diabetes etc
  • Family Medical History
    • e.g. is there a history of early heart disease, diabetes, stroke etc in the family?
  • Smoking History

Anthropometry

You will take some appropriate body measurements as a baseline measure, and for risk assessment (See notes on Anthropometry). These will include:

  • Height
  • Weight
  • Body Mass Index (BMI)
  • Waist circumference
  • Hip circumference
  • Body fat measures

Diet History

A diet history will enable you to take a look at the eating patterns of your client (see computer programme for Diet History sheet).

To complete a diet history, you will go through a typical day. You initiate the process by asking, "What is the first thing you eat or drink, " As many people have varied eating regimes, record several of their common options for each meal. Try and get some indication of the times they are eating and the amounts they are eating. You can also get some idea of weekend variation.

From the dietary history you can get information on:

  • Appropriateness of meal timing e.g. are they leaving too long between meals and then subsequently over-eating?
  • Are their snacks appropriate?
  • Is there a certain time of day which seems to be their "weak-spot"?
  • Are they timing their intake well with their exercise sessions
  • Are they eating appropriate servings of the food groups to ensure adequate micronutrient intake? e.g
    • Are they having at least 2 servings of dairy products or equivalent to ensure adequate calcium?
    • Are they consuming at least 2 serves of fruit per day?
    • Are they consuming at least 3 serves of vegetables per day?
    • Are they consuming at least 1 serve of meat/eggs/pulse, legumes etc per day?
    • Are they consuming wholegrain and higher fibre options?

Discussion of Recommendations

  • Take into consideration the client's goals
  • Identify the changes that you deem appropriate from the diet history and reinforce these
  • Discuss any appropriate nutrition-related health conditions

Provision of Diet Plans

Calculate the amount of calories required to meet goals (see below for calculations):

For Weight Loss, or

For Muscle Gain

Provide the client with the appropriate meal plans which correspond to their energy requirements.

Explain the exchange system where they can interchange meals.

Attitude

Attitude to eating and appetite control plays a significant role in the attainment of goals and for long-term maintenance.

  • You need to briefly discuss the client's attitude to eating
    • It is extremely common for people to eat when they are not hungry. Use the "hungry/fullness questionnaire". This is where clients rate on a scale of 1-10, how hungry they are before they eat and how full they are afterwards. This lets them see if they are eating because they are hungry, if they are overeating, if they have times when they get very hungry and may tend to over-eat. If the client is often around "1", then they are leaving it too late to eat, and if they eat to a "10" they are over-eating.
  • You also need to gauge the extent to which your client may be eating to emotions rather than hunger cues.

Follow-up

Clients most often meet their goals with subsequent follow-up. Meeting fortnightly or monthly can enhance compliance. This is time to:

  • Discuss any problems
  • Repeat some of the anthropometric measurements
  • Perform an impromptu 24-hour recall. This is where you go over what the client has eaten in the previous 24 hours. You can make suggestions from this.