ADIME Note: High Body Fat Percentage

Pt is a 27-year-old female who is being seen for MNT 2/2 increase in body fat percentage even
with weight loss.
Pt stated that she is not eating bread or carbohydrates even though diet recall reveals excessive
CHO consumption in the form of fruit and fruit juice. Pt stated she is using My Fitness Pal to
record diet. My Fitness Pal recommends 1200 calories, allowing for additional calories for logged
exercise. Pt states that she eats 1200 calories or under in attempt to lose weight. Pt stated that
last night she only had a cucumber and tomato slices to lose weight. Pt going to gym 5 times a
week and has a trainer. Pt is wanting to lose body fat to win her gyms body fat loss 90 day
challenge. Has been able to lose pounds but body fat is increasing. Pt reports trainer told her it
could be due to fluctuations in hydration status. Pt is doing cardio training followed by resistance
training, and/or exercise classes.
Food and Nutrition History:
Wakes at 0715
Breakfast 0730- instant oatmeal made with 1 cup almond milk and smoothie with greens, apple,
mint
Snack- Grapes, strawberries, Jell-O
Lunch 1200- Fish, peppers, brown rice, tomato, strawberries and mango juice
Snack- apple or brazil nuts
After gym 1900- 1 scoop whey protein powder in water, plain oatmeal, banana
Dinner 2000- salad, cheese, fish, strawberries, pecans
Fluids- 1 liter of water, pomegranate or green tea several times daily
Anthropometrics:
Height: 67
Current weight: 157 (just had weight loss of 3lbs)
BMI: 24.7
41% Body fat initial measurement at gym, recent loss of 3 lbs yet body fat % increased to 43%
Biochemical:
No reported lab tests
Nutrition Focused Physical Findings:
Pt appears well-nourished
Pt is appears thin, but has high % of body fat especially around her natural waist
Hair, skin, nails appear healthy
No reported N,V,C,D
Client History:
No reported significant medical history
Nutrition Recommendations:
Energy: 25 kcal/kg = 1782 250 (for pound week weight loss) = 1532 kcals/day
Protein: .8-1.0 g/protein/kg = 57-71g
Carbohydrate: 40-50%
Nutrition Diagnosis:

Inadequate energy intake related to food and nutrition knowledge deficit concerning appropriate
energy intake as evidenced by patient reported physical activity level and diet history and fat
percentage increasing 2% in one month.
Nutrition Intervention:
Provided 1500-1600 meal plan and snack options
Eat protein and carbohydrate together for snacks
Reviewed macronutrients and where they are found
Encouraged patient to consume several food groups at each meal setting
Pt should decrease juice consumption or dilute with water. Dont eat fruit and drink juice, one or
the other.
Increase protein, fat and decrease carbohydrate
Reviewed potion sizes of food groups
Discussed what to eat and drink before and after workout and ratio of carbohydrate to protein
(3:1), for most benefit.
Discussed with patient the importance of eating enough to preserve muscle. Told pt that the
only way body fat percentage would decrease is to replace it with muscle.
Pt spoke English as a second language. Native Spanish speaker. Pt acknowledged
understanding. Expect fair compliance.
Monitor and Evaluation:
Weight
Body fat percentage
Diet record