Josephine’s current height and weight are 5’2” and 117lbs. At 20 years old this puts her BMI in the normal range at 21.4 (Bmi-calculator.net, 2018). Even though she has an eating disorder, it’s not until the BMI reaches less than 18.5 that it is considered underweight (Bmi-calculator.net, 2018). Of course, BMI isn’t always the most accurate anthropometric measurement. Body type should be taken into consideration as well as the ratio of body fat mass to lean mass.
The last time Josephine was in my office I put in an order for blood work. I recently received the results of those tests and have been able to evaluate them. Of the five vitamins and minerals, as well as albumin I tested for, only one came within normal range. Her potassium, although on the lower end of the scale was still in the normal range at 3.8 mEq/L. Josephine’s albumin, sodium, iron, and vitamin B12 were all lower than what is considered in normal range. In short, the reason her levels were lower than normal is because her food intake has decreased due to her eating disorder. However, I have assessed her dietary record and looked into why each nutrient was insufficient.
Potassium is essential in maintaining the balance of fluids and electrolytes (Healthyeating.sfgate.com, 2018). I believe the reason Josephine’s potassium levels are at least in range is because navy beans and avocado, both foods of Guatemalan culture, are rich in potassium. Her iron is very low because she is not eating enough red meat or a lot of dark leafy greens (Healthline, 2018). Down the road Josephine may suffer from anemia due to her lack of iron in her diet. I see that she consumes very little meat and dairy which is making her deficient in B12. This deficiency can cause her to experience weakness and fatigue (Skerrett, 2018). Although it’s encouraged to intake a lower amount of sodium to ward off high blood pressure, consuming too little can be harmful as well. Sodium, like potassium, helps our bodies regulate fluids around our cells (Verywell Fit, 2018). Josephine teaches salsa throughout the week and most likely sweats during her classes. I don’t see that she is drinking beverages with electrolytes as she teaches or that her mother cooks with salt, which explains why her sodium is low. Lastly, her albumin levels were lower than normal range. Albumin binds with other substances in the blood and transports the substance to different parts of the body. Josephine’s weight and malnourished state is the cause of her low albumin levels and can lead to the accumulation of fluid in the abdomen and lungs if she does not change her diet (Hepatitiscentral.com, 2018).
After reviewing Josephine’s food record, I see many areas that need improvement. The first recommendation I have for Josephine is to increase her intake of red meats and dark leafy greens in order to increase her iron levels. It will become difficult for Josephine to maintain going to school and teaching salsa classes if she is feeling weak or fatigued. My second recommendation is to add in 2-3 snacks throughout the day. Josephine may feel less guilty about eating snacks if they are healthy. It may also be not as overwhelming to her if the snacks are small. She will not experience feeling overfull and she will also have the added benefit of subtly increasing her caloric intake. Thirdly, I recommend adding some sodium to her diet. This can be in the form of moderate amounts of salt added to prepared foods or even drinking Gatorade in the evenings when she teaches salsa. This will help her body maintain the proper fluid balance.
It’s important to have specific and measurable goals for Josephine to work on in order to improve her diet and overall her health. The first goal is to maintain her weight so that she does not fall into the underweight BMI category. Considering she is teaching salsa throughout the week, Josephine needs to be eating 1,725kcal/day in order to maintain her current weight. I think it’s a good goal for Josephine to commit to meeting her current daily energy requirements. I don’t recommend that she counts the calories herself, but I would like her mother to be in charge of that task, so Josephine does not become obsessed with the number. The second goal I have for Josephine is to increase her dairy intake to 2 servings a day in the form of 2 snacks. The first snack can be Greek yogurt with fresh fruit and granola and the second snack can be whole-wheat crackers with a soft cheese spread and avocado slices. This increase in dairy will help increase her B12 intake. My last goal for Josephine is to make a conscious effort to consume one 16fl oz. bottle of Gatorade on the nights she teaches salsa. This increase in sodium will stabilize her fluids and prevent her from becoming dehydrated or weak, while also contributing to her daily energy requirements. I believe that these are manageable goals for Josephine, especially with the support from her family.
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