Assessing Patients: A Nutrition Guide for Integrative Practitioners

With a foundational knowledge, practitioners can begin to work with patients. The first step is to assess their needs, goals, and current health status, which may differ for practitioners who have worked with their patients previously.

When beginning to work with a nutrition patient, a food log is helpful in assessing their food intake. In a general sense, consider analyzing food logs more so in the beginning. This will tell you a lot about their current eating norms. If patients continue to need more intensive scrutiny of their food logs, then you can continue consulting with them.

If your patient begins to show compliance and results rather quickly, you may not feel compelled to check food logs every week. Food logs can be tedious to keep and analyze. To make things easier, you will want to be sure that your patient is clear on what information needs to be included in their food logs.

Items included on food logs should be clarified if there are any questions. Often, people will put down food descriptors that require follow-up. Investing the time in making the instructions clear and up-front can expedite the process. Generally, food logs should include the following:

• Food item
• Portion size 
• Time of day
• Homemade, store-bought, or restaurant?
• Any food labels attached?
• Any comments on emotional status

Once your patient has done several food logs, review actual intake totals with what was designed in their eating strategy. Take the time to set goals for the next week. If you can, experiment with having your patients commit to one or two small changes between appointments and, in this way, you positively reinforce a good behavioral goal.

Practitioners may also need to assess patients’ body composition, especially if their goal is weight loss. Body fat, in the ideal range, informs the practitioner as to the general health status of their patient and, as such, plays an important role in the health and fitness goals of all individuals.

Many options exist to assess human body composition. Of the simpler methods, the popular height–weight tables have become a frequently used standard in the medical community, or for insurance purposes. But to assess overweight and obesity status accurately and properly, practitioners should know more. Using Body Mass Index (or BMI) is one way we can assess our patient’s body composition. Patients are encouraged to keep our BMI under 24.9 to optimize health and to prevent the onset of chronic diseases brought on by obesity.

Unfortunately, use of BMI alone is of limited usefulness to practitioners, since “overweight” and excess body fat does not necessarily mean the same thing. A better alternative would be to determine body composition and this is done by assessing body fat. Body fat can be measured in a number of ways:

• Hydrostatic weighing
• Skinfolds
• Girths
• Bioelectrical analysis
• Dual energy x-ray absorptiometry

When body fat measures are available, it becomes possible to more accurately place body fat (BF) level on a continuum from low to high, independent of body weight. The American College of Sports Medicine sets the standards of body composition as follows:

• Ideal: 16-19 percent BF for females; 11-13 percent BF for males
• Obese: Greater than 32 percent BF for females; greater than 25 percent BF for males

You may be asking yourself, what is “ideal” or what does “average” mean? How does it relate to your patients? This is where your coaching skills will lead you down a path of discovery about your patients. Using compelling questions and intuition, you can dig deeper with patients about the “why” behind their goals, especially when your intuition tells you that a patient may have unrealistic goals in mind.

Editor’s Note: This is an excerpt from the e-book, An Introductory Nutrition Guide for Integrative Practitioners. To access the full text, click here.