Practice Consideration
It is a crucial part of the Nutrition Assessment process to determine the patient’s knowledge of nutrition. If the patient appears to lack knowledge or “does not know where to start”, further exploration of his knowledge base is warranted. What does the dietitian really know about Mr Robertson’s knowledge of nutrition at this point? Information about nutrition is readily available on the internet, from family and friends and in print media. The statement about not knowing where to start may indicate that he is feeling overwhelmed by recent changes, or is apprehensive about having to make more changes in order to lose weight. The following scenario offers techniques to involve the patient in open, two-way communication in order to gain insight into knowledge and understanding of nutrition.
Scenario
Mr Robertson remarks that he “does not know where to start” in changing his diet and lifestyle. This information provides a useful reference point for the dietitian, who can incorporate it as an introduction to a joint evaluation of the diet history. This in turn may reveal the patient’s level of nutrition knowledge and enables the dietitian to choose an appropriate diet-assessment method.
Strategy
The dietitian could use the exchange list (and Activity 1.2) to evaluate Mr Robertson’s energy intake. Before commencing the evaluation, the dietitian asks permission to discuss the patient’s thoughts about his daily dietary intake:
“Earlier, you mentioned that you weren’t sure where to start with making changes that would help you maintain a healthier weight. Might I share one way that we could look at your intake?”
Mr Robertson replies, “Of course!”
Engaging the Patient in the Diet Assessment
The dietitian might then choose the simplest way to assess the diet history, explaining that a more thorough analysis will be ready for discussion at the next consultation.
For this initial consultation, the dietitian asks if the food groups (see Activity 1.4) are familiar. If the answer is “no”, the dietitian can provide a brief explanation of the food groups, for example:
“We group foods together based on nutrient and energy content so we can see if your diet is balanced and providing optimal nutrient levels. Let’s take a look at the information you gave us in your diet history and put the foods into these categories.”
The patient and the dietitian would then go through the diet history together and group the foods into the guideline categories. The dietitian might show the totals, and ask whether they indicate an optimal number of servings from each category.(1,2) The dietitian might say something like:
“May I share what would be considered a recommended intake from each category?”
The dietitian would then provide the recommended servings and explain how these were devised. If the dietitian plans to recommend reducing servings—for example, having zero occasional foods—he or she might provide a brief explanation of why this would be different from “normal recommendations” for someone of the same age, gender and activity level. The dietitian might also explain that, even within a food category, choice of serving size will vary. The patient can be asked to identify foods on the list that contain the greatest amount of energy, while lacking other important nutrients. If Mr Robertson does not single out foods such as butter, cookies, ice cream, chocolates, chips, fruit cake, donuts, bacon and alcohol, the dietitian will offer to identify some of the foods to be eaten “once in a while”, but not at every meal, or even every day. Mr Robertson identifies most of the undesirable foods, but not alcohol or butter.
Throughout this process, the dietitian is gathering information and assessing the patient’s knowledge and understanding of nutrition. When there is a knowledge shortfall, the dietitian decides whether it is important to discuss the information at this a later time.
References
- Dietitians Association of Australia. Best Practice Guidelines for the treatment of overweight and obesity in adults. 2011; Accessed 8 August 2017. Available from: www.daa.asn.au/wp-content/uploads/2011/03/FINAL-DAA-obesity-guidelines-report-25th-January-2011-2.pdf (NOTE: Dietitians Australia recognize the need and have called for a revision of these guidelines)
- Evidence-based Nutrition Practice Guideline on Adult Weight Management published 2022 at https://www.andeal.org/ and copyrighted by the Academy of Nutrition and Dietetics. Accessed 26 August 2024: https://www.andeal.org/topic.cfm?menu=5276.