Human Growth and Development Discussions

562 Chapter 15 | Weight Management

NUTRITION in PRACTICE: Sports Medicine Specialist and PT

Adam is a 40-year-old Fine Arts professor who has gained 20 pounds over the last year. He blames his weight gain on the nagging pain in his shoulder, which has caused him to drop out of the faculty tennis league. Adam used to play league tennis games three to four times a week and practice drills on the weekend. Unhappy with his excess weight, Adam decided to visit the campus health center. While he was at the center, he saw a flyer advertis- ing the new Sports Medicine Clinic on campus, adjacent to the Health Center. Adam made an appointment with the sports medicine specialist, a physician who specializes in sports medicine, for the next day. The doctor diagnosed his shoul- der soreness as impingement syndrome, which is pain sometimes experienced by tennis players when they lift and rotate their arm. The doctor referred Adam to the physical therapist (PT) at the clinic for guidance for an exercise program that would strengthen his shoulder muscles to ease the pain. To help him lose his excess weight, the doctor recommended that Adam visit with the registered dietitian nutritionist (RDN) at the clinic.

Adam’s Stats ❏ Age: 40 ❏ Height: 6 feet ❏ Weight: 210 pounds ❏ BMI: 28.5

Critical Thinking Questions 1. Based on Adam’s food log, which

waist-friendly food groups are missing from his diet?

2. Why do you think Adam is snacking between meals, even when he isn’t very hungry?

3. What beverage recommendations would you make based on Adam’s food log?

PT’s Observation and Plan for Adam ❏ Explain that impingement syndrome

occurs when the tissues in the shoul- der are pitched or compressed due to poor mechanics.

❏ Provide Adam with a strengthening pro- gram for shoulder stabilizing muscles.

RDN’s Observation and Plan for Adam

❏ Discuss the lack of adequate amounts of whole fruits and vegetables in his diet and the role these high-fiber, high- volume, lower-energy-dense foods play in weight reduction. Explain the concept that these foods displace other higher-kilocalorie foods in the diet and “fill you up before they fill you out.”

❏ Discuss the issue of routinely snack- ing when not hungry. Consider alter- natives to eating when bored.

❏ Replace the bowl of energy-dense granola cereal with lower-kilocalorie shredded wheat cereal with a sprin- kling of granola as a topping.

❏ Substitute skim milk for whole milk on his cereal and the cream in his coffee.

❏ Decrease the size of the sandwich at lunch. Instead of a large sub, order a small sub and a side salad with light dressing.

Two weeks later, Adam returns for a follow-up visit with the RDN and PT. While he has only lost a pound, he is feeling better about this diet and the strengthening program that the PT designed for him, although his overhead tennis serve is still somewhat painful. He has added more fruits and vegetables to his diet and, surprisingly, doesn’t feel hungry. The RDN works with Adam to choose leaner sources of protein at lunch and dinner. Adam agrees to try a smaller turkey sandwich at lunch and grilled salmon or chicken for dinner more often. He made another appointment to see the RDN in a month. The PT tweaks Adam’s strengthening program and continues to work with him through the month.

Adam

ADAM’S FOOD LOG

Food/Beverage Time

Consumed Hunger Rating* LocationGranola with whole milk, orange

juice, coffee with cream 7:00 A.M. 3 Kitchen

Coffee with cream, donut 10:30 A.M. 2 Campus coffee shopHam and cheese sub 1:30 P.M. 5 Sub shop on campusCookies 4:00 P.M. 1 Vending machine in faculty loungeSteak, rice, and corn 6:30 P.M. 3 Kitchen

Peanuts 9:00 P.M. 1 Watching TV*Hunger Rating (1–5): 1 = not hungry; 5 = super hungry.

600 Chapter 16 | Nutrition and Fitness

Dalton was recruited with a full scholarship to be a guard on the college basketball team. He was the star basketball player in high school and played with a travelling team. While he was used to heavy schedule of games and practices in high school, his college routine of games, practices, and weight train- ing six days a week is taking a toll on this energy level. He finds he is getting tired before the end of practices and doesn’t have the stamina to play all four quarters of the game. Dalton understands how important his performance is to retaining his athletic scholarship, so he met with the team Athletic Trainer (AT) to see if he should change his training routine. The AT asked Dalton if he is getting adequate sleep and how he is doing in school. Dal- ton told the AT that he sleeps soundly at night and that his school work was man- ageable. The AT then asked about his diet. When Dalton told him what he typically eats daily, the AT recommended that Dal- ton make an appointment with the team’s Registered Dietitian Nutritionist (RDN), who has a specialty in sports nutrition.

Dalton’s Stats ❏ Age: 18 ❏ Height: 6 feet 4 inches ❏ Weight: 205 pounds ❏ BMI: 25 ❏ Percent Body Fat: 9%

Critical Thinking Questions 1. What nutrient is missing from Dalton’s

diet, possibly contributing to his fatigue? 2. Is Dalton’s food timing appropriate for

his exercise performance? What recom- mendations would you make to improve the timing of his meals and snacks?

3. What changes should Dalton make in his diet in the evening and why?

RDN’s Observation and Plan for Dalton:

❏ Discuss the importance of consuming adequate amounts of carbohydrates at his meals to achieve optimal energy storage as liver and muscle glycogen. If there is not adequate carbohydrate intake before a practice and game,

NUTRITION in PRACTICE: Athletic Trainer

the body’s fuel storage will be quickly depleted.

❏ Recommend Dalton add vegetables to his omelet and add a salad, fresh fruit, or vegetables to his lunch. The RDN also recommends Dalton change his dinner choices to include grilled or sautéed chicken, rice, and more veg- etables to increase his carbohydrates. The increased fat content of fried chicken may slow the absorption of carbohydrate and protein.

❏ Discuss the need for Dalton to have more snacks during the day to allow increased accessibility to kilocalories and to better balance intake and output of energy. The large gap between breakfast and lunch should be reduced to help sustain his energy over the course of the day. The RDN recommends that Dalton eat cereal and milk as a midmorning snack.

❏ Recommend Dalton continue drink- ing a carbohydrate-containing sports drink during games to maintain blood glucose levels, slow glycogen deple- tion, and provide fluid for hydration. Also recommend he eat a protein bar before and after the event, rather than during, to help with protein sparing and muscle recovery.

Two weeks later, Dalton returns for a follow-up visit with the RDN. He is feel- ing less fatigued and the increased food opportunities during the day are enabling him to have more stamina during his games and practices. However, he is getting bored with the evening snacking and wants more food choices. The RDN recommends that he try baked beans on toast, beef jerky and crackers, potatoes and eggs, granola and cottage cheese, or chicken and rice as an evening snack.

Dalton

DALTON’S FOOD LOG

Food/Beverage Time

Consumed Hunger Rating* Location3-egg omelet with

ham and cheese, hash browns, and sports drink

8 AM 5 Dining hall

3 oz. cheeseburger, fries, sports drink

1:00 PM 4 Dining hall

16 ounces sports drink; 3 protein bars

3:00 PM (before and dur- ing his 3 hour practice)

3 Basketball court

10 oz. fried chicken, mashed potatoes, corn

7 PM (after practice) 5 Fast-food eatery with teammates* Hunger Rating (1–5): 1 = not hungry; 5 = super hungry.