Case Study Analysis: Food and Nutrition in Nursing Practice, NS3119

This case study analyzes the nutritional needs and challenges of two individuals, Jim and Mike, focusing on weight loss strategies, dietary recommendations, and the impact of various interventions. It addresses realistic weight loss goals, the effects of childhood obesity, and the dangers of yo-yo dieting and weight cycling. The case study examines the use of dieter's tea and St. John's wort, evaluating their potential side effects and benefits. It also explores the use of BMI to assess obesity levels and the suitability of bariatric surgery, discussing its potential complications and alternative nutritional approaches. The study emphasizes the importance of behavioral changes, including exercise and dietary guidelines, and the role of a registered nurse in promoting self-management and patient education to achieve sustainable weight loss and improve health outcomes. The assignment also references the Australian Dietary Guidelines and the Department of Health's physical activity guidelines.

Running head: FOOD AND NUTRITION: CASE STUDY
FOOD AND NUTRITION: CASE STUDY
Name of the Student:
Name of the University:
Author note:

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Question 1
In order to formulate realistic objectives for the purpose of weight loss, Jim and Mike
must aim to lose 10% of their body weight over the course of 6 months or 24 weeks. Hence, the
weight loss aims for Jim and Mike are as follows:
Anthropometric Measurements for Mike
 Mike’s present weight: 85 kg
 10% of weight: 10/100 *85 = 8.5 kg
 Hence, Mike should aim to achieve a weight of: 85 – 8.5 kg = 76.5 kg, after losing 10%
or 8.5 kg of weight within the next 6 months (24 weeks)
Anthropometric Measurements for Jim
 Jim’s present weight: 153 kg
 10% of weight: 10/100 * 153 = 15.3 kg
 Hence, Mike should aim to achieve a weight of: 153 – 15.3 kg = 137.7 kg, after losing
10% or 15.3 kg of weight within the next 6 months (24 weeks)
While it is not uncommon for individuals to engage in significantly challenging weight
loss goals, the same can result in future regaining of weight and loss of self-confidence. For
successfully fulfillment of unrealistic goals of weight loss, Jim and Mike will be required to
engage in stringent and highly depriving or inadequate dietary practices (Lent et al., 2016).
While such practices may result in rapid weight loss in Jim and Mike, the same may also lead to
loss of motivation, cravings, hunger pangs and nutritional deficiencies further resulting in
relapsing of previous unhealthy practices and increased weight gain (Kozica et al., 2015). This

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may further result in Jim and Mike feeling highly discouraged to engage further in any future
weight loss or dietary practices. Hence, realistic weight loss goals of 10% over the next 6 months
will not only result in sustainable losses in weight but will also keep Jim and Mike motivated,
satisfied and free from deficiencies (Holley et al., 2016).
Question 2
Childhood obesity is likely to exert detrimental physiological and anthropometric effects
during adulthood as well, as observed in Jim and Mike (Singer & Lumeng, 2017). Individuals
who are overweight or obese during childhood, are predisposed to be in possession of a
persistent state of obesity. The same has been observed in Jim and Mike, who continue to remain
obese during adulthood after their obese during childhood as well. Childhood obesity hence
effects current weight during adulthood if left untreated due to a tendency to maintain childhood-
acquired lifestyle and dietary behaviors throughout the lifespan. Hence, this results in childhood
obesity affecting body weight during adulthood (Krystia et al., 2019). As observed in Mike and
Jim, not only were they obese as children but have been unable to overcome their childhood
dietary habits of eating milk and biscuits and an old fashioned diet of meat, cheese, eggs and
potatoes – that is, food habits which are high in saturated fats, sugars and starches. Childhood
obesity will not only affect their current weight in terms of maintenance of obesity but also result
in weight loss difficulties due to predisposed dietary and lifestyle habits. If left untreated,
childhood obesity and maintenance of the same during adulthood will further result in future
acquisition of cardiovascular disease, diabetes, hypertension, dyslipidemia, bone disorders, renal
as well as hepatic disorders along with cancer and obstructive sleep apnea (Ayer et al., 2015).

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Nutritional Recommendations
However it is worthwhile to mention that despite the effects of childhood obesity on their
present weights, Mike and Jim will be able to reverse the harmful health issues associated with
obesity, by practicing adequate levels of physical activity and consumption of a diet low in
saturated fats, calories and sugars and containing moderate amounts of proteins, complex
carbohydrates, unsaturated fats and dietary fiber resulting in sustainable weight loss and positive
health outcomes (Wen et al., 2015).
Question 3
The dietary characteristics of ‘yo-yo dieting’ is also known as ‘weight cycling’ and
encompass frequent, alternating phases of weight loss and weight gain, where in an individual
engages in unrealistic weight loss goal fulfillment resulting in loss of motivation and a relapse to
previous unhealthy dietary habits resulting in recurrent weight gain and a vicious weight
fluctuating cycle (Madigan et al., 2018). Weight cycling is a prevalent feature in individuals who
frequently engage in starvation induced weight loss and lose ability to adhere to the same in the
long run. One of the most detrimental effects of yo-yo dieting is that it may increase one’s
susceptibility to gain weight at rates greater than what was prevalent before (Dulloo & Montani,
2015). This is due to the fact that weight loss due to unrealistic dietary habits results in the body
acquiring a ‘starvation response’. During such a stage, the human body perceives the inadequate
food consumption as a state of starvation and resorts to a hypo-metabolic state to conserve
energy and nutrients (El Ghoch, Calugi & Grave, 2018). Hence, after reverting back to previous
habits of high obesity-inducing food habits, the body converts acquired nutrients into fat for
energy conservation resulting in adipose accumulation and higher weight gain than previous state

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of obesity (Yokomichi et al., 2017). Starvation in yo-yo dieting also results in detrimental health
effects such as nutritional deficiencies, muscle loss, weakness and adiposity induced
hepatomegaly, diabetes, cardiovascular diseases, hypertension and loss of motivation to dedicate
oneself towards long term lifestyle changes (Montani, Schutz & Dulloo, 2015).
Nutritional recommendations
To counter the effects of yo-yo dieting, Mike and Jim must engage in realistic weight loss
goals of 10% loss over 6 months. They must consume a realistic and balanced diet rich in all the
essential food groups as this will avoid discouragement, starvation and improvement of the
body’s metabolic processes (Garcia & Bernavidez, 2016).
Question 4
Dieter’s tea is a product commonly used by individuals to relieve symptoms of
constipation as well as lose weight. Such a tea is usually prepared using extracts of a plant named
senna, which has been known to exert properties of laxatives (Kılıç et al., 2017). While dieter’s
tea has been associated with mild weight loss, its consumption if often associated with
detrimental side effects. The side effects are caused due to the laxative effects of senna resulting
in gastrointestinal discomfort, bloating, cramping, nausea (as observed in Mike) diarrhea and the
resultant loss in electrolytes like potassium, arrhythmia and abnormal muscle contractions
(Turtay et al., 2018).
St John’s wort, known as Hypericum perforatum, is herb widely recommended for the
treatment of individuals with symptoms of depression. Considering that depression has often
been associated with a disruptive appetite and weight gain, this herb has often been
recommended as a herbal supplement by which individuals can lose weight, and hence can be

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related to why Mike attempted to consume the same (Booker et al., 2018). St John’s wort has
also been reported to improve levels of energy, concentration and alertness further resulting in
improved engagement towards exercise meant for weight loss (Schmidt & Butterweck, 2015).
However topical or oral consumption of this herb may result in harmful side effects due to its
components hyperforin, hypericin and psuedohypericin which exert stimulant-like effects
resulting in sleeplessness (as observed in Mike), gastrointestinal disorders, headache, anxiety,
fatigue and giddiness (Avila, Whitten & Evans, 2018). One of the most dangerous effects of St
John’s wort is serotonin syndrome, where its overconsumption or combination with
antidepressants may abnormally increase the levels of serotonin resulting in hallucination, loss of
consciousness, shakiness, palpitations and muscle coordination loss. Additional components like
hypericin and hyperforin may enhance one’s sensitivity to sunlight resulting in rashes
(Soleymani et al., 2017).
Question 5
Anthropometric Measurements: Body Mass Index (BMI)
BMI for Mike
 Weight: 85 kg
 Height: 1.78 m
 BMI: Weight (Kg)/Height (m2): 85/3.16 = 26 kg/m2
BMI for Jim
 Weight: 153 kg
 Height: 1.83 m

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 BMI: Weight (Kg)/Height (m2): 153/3.34 = 45 kg/m2
While Jim decides to undergo surgery for both him and his brother, Jim himself, may be a
more suitable candidate for the same. Surgical procedures for weight loss known as bariatric
surgery, is generally recommended to those individuals who are possession of a high BMI above
40, indicating serious and morbid obesity and have been unsuccessful to lose weight otherwise
via conventional weight loss and dietary methods (Donkin et al., 2016). Jim is under serious and
harmful levels of obesity and is in possession of a high BMI of 45 as compared to his brother
Mike. He is also a suitable candidate for bariatric surgery meant for weight loss due to is
previously unsuccessful attempts for the same, in the form of exercise adherence or consumption
weight loss supplements (Angrisani et al., 2015).
Question 6
While surgical procedures like bariatric surgery has been associated with possible
benefits in the form of weight loss, the same, may not hold true for Jim and Mike. Bariatric
surgical procedures like laparoscopic adjustable gastric band (surgical stapling, as desired by
Jim), gastric bypass and gastric sleeve surgeries bring forth a number of physiological
complications (Anderin et al., 2015). Complications as a result of surgical stapling procedures
include possibilities of hernia, separation of the skin or gastric tissues and high susceptibilities of
the band breaking, slipping, eroding and deflating (Concors et al., 2016). Further, such surgeries
may result in the brother suffering from a host of short term gastrointestinal complications and
health risk such as esophageal dilation, acid reflux or regurgitation, stomach obstructions,
feelings of vomiting and nausea, loss of ability to consume certain foods and possibilities of
starvation induced obesity acquisition in the long run (Brethauer et al., 2015). Surgical

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procedures such as the above may also result in long term negative health outcomes and reduced
quality of life in the brothers such as vomiting induced nutritional losses, deficiencies and poor
nutritional status and malnutrition, esophageal ulcers due to gastric reflux, hypoglycemia and
gastrointestinal disorders such as Dumping syndrome associated with fatigue, dizziness, nausea
and vomiting (Hakins & Maheswaran, 2016).
Nutritional Recommendations
Hence, considering the above surgical complications, Jim and Mike must focus upon
adherence to sustainable and long term lifestyle and dietary changes and goals. These will
include engagement in moderate levels of physical activity and consumption of a balanced diet
rich in core food groups of grains, fruits, vegetables, dairy, lean meats and unsaturated fats. Such
realistic long term goals will not prevent occurrences of the above surgery associated health
complications but also result in successful, sustainable weight loss and positive health outcomes.
Question 7
Behavioral Changes
As per the Department of Health’s ‘Australia Physical Activity and Sedentary Behavior
Guidelines’ Jim and Mike must engage themselves in behavioral changes of exercise
incorporation which will require of them to perform 75 to 100 minutes and 150 to 300 minutes of
vigorously intense and moderately intense levels of physical activity every week, on most days
of the week if not every day (Department of Health, 2019). As per the Australian Dietary
Guidelines, Jim and Mike must consume a balanced milk consisting of core food groups of
whole grains, lean or vegetarian meats, unsaturated fats and low fat dairy (Mishra et al., 2016).
For weight loss and health weight maintenance, Jim and Mike must avoid red meat consumption

8FOOD AND NUTRITION: CASE STUDY
(bacon), consume lean, fat-trimmed meats like fish or chicken, reduce saturated fat intake like
cheese and sugary foods like biscuits, consume low fat dairy like skimmed milk and reduce
potato consumption and compensate with whole grains (Bookari, Yeatman & Williamson, 2016).
Nursing promotion of Self-Management
The registered nurse (RN) must first educate Jim and Mike considering the complications
associated with obesity and the importance of balanced diet consumption and exercise
adherence. Following the same, the nurse can engage in patient centered approach and encourage
Jim and Mike in the formulation of realistic and customized weight loss goals based on which a
care personalized care plan for the two can be formulated (Laws et al., 2015). For the fulfillment
of the above behavioral and personal self-management goals, the RN can conduct a
multidisciplinary approach and collaboratively work with a nutritionist who will not only
developed a balanced meal for Jim and Mike, but will also consider their personal needs and
preferences of an old fashioned diet or milk and biscuits for personalized modifications (Schiavo
et al., 2019). The RN may also work inter-professionally with a fitness expert who can supervise
Jim and Mike on practice of mild aerobic and strength oriented activities (Figueiredo et al.,
2017). The RN may also work collaboratively with a counselor who may help Jim and Mike
regulate their unhealthy behaviors through administration of social learning theories and CBT
(Minshall & Braet, 2017). The RN must engage herself in weekly assessment, screening,
monitoring, evaluation and follow up of Jim and Mike where she will measure their
anthropometric measurements of weight, BMI and waist circumference and conduct patient
centered feedback requiring questioning Jim and Mike on their expectations, preferences and
experiences concerning the multidisciplinary weight loss services offered (Tucker &
Lanningham-Foster, 2015). Most importantly, the RN must practice standard 1.1 and deliver

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quality nursing care to Jim and Mike and engage in principle 2 of patient centred care under
NMBA standards (Nursing and Midwifery Board of Australia, 2019).

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References
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https://doi.org/10.1007/s11695-015-1657-z.
Avila, C., Whitten, D., & Evans, S. (2018). The safety of St John's wort (Hypericum perforatum)
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