Patient
KA

Height: 4 ft 11 in

Weight: 170 lbs

BMI: 34.3

Registered Dietitian

Gabrielle Kishner, RD

Insurances: Aetna,Anthem,Blue Cross Blue Shield,Cigna,United Healthcare

Diagnosis and Treatment Plan

Changes / challenges since last visit

Pt presents to follow up session for nutrition counseling related to binge eating, obesity, PCOS, and recently diagnosed high cholesterol.

Changes since last nutrition visit:

Pt presents to visit noting things have been "going ok" recently. She notes she recently graduated from school, which has been a big relief. She notes she has been less stressed and has more free time. She explains her sleep has slightly improved due to her wearing her CPAP machine at night.

Pt notes that following our discussion on cholesterol lowering foods and cholesterol raising foods in last discussion, she has been adding flax seeds into her smoothies when she makes them. She denies making any other dietary changes following our discussion on cholesterol.

Pt notes she has been using hello fresh for dinners. She notes she enjoys this because it "gives her a sense of portion control." She notes she has been ordering lemon herbed chicken; a chicken grain bowl; pork tacos, etc.

Pt notes she has been working out 2x/day, noting that she will go to Orange theory and yoga each day now that school has ended. She notes that she has been feeling slightly more tired due to this increased activity, noting that she has noticed she does not feel like she is "giving orange theory her all." She notes that since she has been working out at night, she feels more hungry at night. She notes she does not eat at night and will go to bed hungry.

Of note, pt explains that last night she felt like "she ate everything in sight." She explains that she did not eat a lot throughout the day and notes she felt starving at night. Pt notes she understands this is due to her not eating enough throughout the day.

Pt notes her water intake has been "good" and she feels adequately hydrated.

Nutrition Education Provided:

  • Reviewed the importance of eating consistently throughout the day in order to minimize blood sugar drops and spikes
  • Emphasized the importance of honoring hunger levels, encouraging pt to incorporate a protein heavy snack (i.e. protein shake) after a workout
  • Emphasized including high quality protein sources and brainstormed those that pt would enjoy (eggs, chicken, fish, etc.). Discussed convenient/accessible sources of these such as: canned tuna/salmon, rotisserie chicken, Greek yogurt.
  • Discussed the concept of movement and how movement should be joyous and not something we feel like we need to do daily
  • Discussed the benefits of HIIT workouts 4x/week for PCOS management, encouraged pt to honor her energy levels and not feel like she is overdoing it
  • Discussed inositol supplement and how this has been studied to help improve blood sugar management for PCOS pts
  • Encouraged pt to continue prioritizing sleep as lack of sleep and increased stress can cause increased sugar cravings
  • Educated on how minimizing saturated fat, including more (soluble) fiber, and exercising can help lower LDL. Reviewed ways to incorporate more unsaturated fats and improve HDL
  • Encouraged pt to focus on non-scale wins (i.e., improved energy, mood, or digestion; fewer restrict or binge urges) rather than weight.
  • Discussed how an “all foods fit” model can help prevent the restrict-binge pendulum from occurring. Discussed how avoiding or restricting a food/ingredient can worsen relationship w/ food and binge urges - leads to putting food on a pedestal which can cause us to lose control around food.
  • Educated pt about how restriction is #1 predictor of binging and how undereating can lead to overeating or binge episodes. Encouraged consistent/adequate eating to help prevent binges from occurring.
  • Discussed how avoiding or restricting a food/ingredient can worsen relationship w/ food and binge urges - leads to putting food on a pedestal which can cause us to lose control around food.
  • Discussed importance of getting nutrition information from reliable sources such as registered dietitians instead of the general public, emphasizing that what works for one person may not necessarily be the "best option" for that one person and does not mean that will work for everyone

Meal plan updates

Dietary Recall Obtained:

Breakfast: eggs with onions, tomatoes, hallipinos, eggs OR yogurt parfait with strawberries, granola and peanut butter

lunch: sushi *Of note, pt notes she cannot recall any other lunch options she has been eating, but endorses eating lunch daily.

snacks: bobo peanut butter and jelly snacks, beef sticks

Dinner: orders from hello fresh - lemon herbed chicken, chicken and grain bowl, pork tacos, etc.

Topics Discussed

Weight Loss

Appointment History

Number of Sessions: 13

Last Updated: May 24, 2024