Medical Nutrition Therapy….PEIA Weight Management Encounters

MNT EncountersScheduled RD/Client MNT encounters:

Initial encounter: 60 minutes , month 2

Follow up encounters: 60 minutes month 4 30 minutes month 6 60 minutes month 13

*If the participant is in Attempt 2 of the program, they will not receive the month 13 follow up encounter as Attempt 2 is 12 months in duration.

MNT EncountersAdditional visits can be requested when

needs arise by contacting the PEIA Weight Management Office

Considered on a case by case basis for approval

What may be approved?Changes in medical dxSignificant changes in nutrition related medsStruggling clients

Initial MNT Encounter60 minutesReview initial intake information to

familiarize yourself with your client before contact.

When scheduling first encounter, take the time to ask a few questions and get a feel for your client.

Double check medical dxRequest they keep a food diary for a few days

or fill out a food frequency questionnaire (can email it to them) to get a baseline intake to work from.

Initial EncounterFollow the Nutrition Care Process

Nutrition Assessment

Nutrition Diagnosis

Nutrition Interventions

Nutrition Monitoring/Evaluation

Initial EncounterClient Interview: basis of the nutrition

assessmentUse your Motivational Interviewing skills

MI assists clients in gaining awareness of thoughts and feelings that are foundation of behavior.

Explores ambivalence; increases motivation for change

Put your client in the “driver’s seat”. What are their personal goals and priorities?

Initial EncounterInterviewing, continued:

True power of change rests within the client.

Your job: to draw out the client’s own motivation and skills for change- not to tell them what to do or why they should do it.

Lasting change more likely to occur when the client discovers their own reasons and determination for change.

Initial EncounterInterviewing, continued

Principles Express empathy- see the world through your

client’s eyes Support Self-Efficacy- focus on previous

successes and highlight skills and strengths Roll with Resistance- “dance” rather than

“wrestle” with your client; explore client concerns and invite them to examine new points of view; careful not to impose your own way of thinking

Develop Discrepancy- help them discover where they are in relation to where they want to be

Initial EncounterAssessment

Eval ht, wt, wt history, BMI, WC, Biochemical data, Physical findings

Measure or estimate RMR (using Mifflin-St.Jeor at actual BW) and adjust for PA level. Estimate needs for wt loss of 1-2lb/wk.

Document client’s food and nutrition hx- baseline diet hx/intake pattern, PA pattern, nutrition and health awareness, food availability and psychosocial or economic issues impacting nutrition therapy

Initial EncounterAssessment continued:

Assess prescribed meds, OTC supplements and potential for interactions

Assess the client’s knowledge base, motivation level and confidence/readiness to change diet and PA

Consider co-morbid conditions and need for incorporating other Nutrition Practice Guidelines

Initial EncounterNutrition Diagnosis

List and prioritize the nutrition diagnosis (es) using a PES statement (Problem, Etiology, Signs/Symptoms)

Most Common Dx for Weight Management: Excessive energy intake (NI-1.5) Excessive oral intake (food/bev) (NI-2.2) Inappropriate intake of fats (specify) (NI-5.6.3) Inappropriate intake of types of CHO (specify) (NI-

5.8.3) Inadequate fiber intake (NI-5.8.5) Overweight/Obesity (NC-3.3)

Initial EncounterMost common Nutrition Dx, continued

Food-Medication interaction (NC-2.3) Food and Nutrition related knowledge deficit (NB-

1.1) Not ready for diet/lifestyle change (NB-1.3) Limited adherence to nutrition related

recommendations (NB-1.6) Physical inactivity (NB-2.1)

Others may apply r/t co-morbid factors

Initial EncounterNutrition Intervention:

Individualize the Nutrition PrescriptionWork with the client in establishing

appropriate and reasonable interventions to address the etiology of their nutrition dx.

Work with client on appropriate nutrition education/counseling and assist in selecting appropriate behavior therapy strategies (ie: self monitoring, stress management, stimulus control, contingency management, social support, etc)

Initial EncounterIntervention continued:

Have client assist in setting goals (measurable, reasonable/achievable, timed)

Indicate materials provided and resources given/used (ie: items from starter kit, web resources, on line trackers, etc .)

Indicate referrals made if any

Initial encounterMonitoring/Evaluation

Indicators to measure are determined by nutrition dx, etiology, s/s, as well as health care outcomes.

Identify nutrition care outcomes to be monitored and/or what they evaluate

On follow up should provide evidence that intervention is/is not changing behavior/status

Follow up Encounters30-60 minutes as assignedRe-interviewAssessment:

Reassess anthropometrics, biochemical data, med changes.

Obtain brief diet hx and eval client’s adherence to diet plan/intervention strategies

Determine adherence or barriers to learning or implementing behavioral changes

Compare expected outcomes and goals

Follow up Encounters

Nutrition Dx

Based on initial encounter, progress and current goals, list and prioritize new or continued diagnosis (es)

Use PES statements

Follow up EncountersNutrition Intervention:

Reinforce or modify nutrition prescription and assist client in setting behavioral goals focused on the etiology of the problem.

Reinforce/modify goals for PA and behavior therapy strategies as appropriate

Note materials provided, resources given/usedReferrals or requests for follow up labs prn

Follow up EncountersMonitoring/Evaluation:

Determine client’s understanding of nutrition intervention

Any new indicators to monitor??

Compare nutrition care outcome indicators against specified standards- may establish your own comparison criteria as not all clients will be able to achieve goals established by a national standard-document progress or lack thereof

Resources to check outAcademy of Nutrition and Dietetics Adult Weight

Management Evidence-Based Nutrition Practice Guidelines: www.evidencelibrary.com

Academy of Nutrition and Dietetics Adult Weight Management Tool Kit

Academy of Nutrition and Dietetics Nutrition Care Manual section for Overweight and Obesity http://nutritioncaremanual.org

Academy of Nutrition and Dietetics Nutrition Care Process and Standardized Language www.eatright.org/ncp

Pocket Guide for IDNT: Standardized Language for The Nutrition Care Process (now in 4th ed.)

MNT Encounters

Questions??Contact Information:

Cathy Shaw, RD, LDRD Program CoordinatorPEIA Weight Management Program304-293-6652Catherine.shaw@mail.wvu.edu