Imagine yourself in the role of a nutrition counselor, and Josephine is your client. Josephine is a 20-year-old female who presents with a purging disorder, an “Other Specified Feeding or Eating Disorder” (OSFED). She currently teaches salsa lessons at the community college and is in her last semester of college. She reports she is living at home, and the food her mother prepares is not the healthiest because her mom is from Honduras and her father is from Guatemala, so the food is prepared differently. She indicates she has been thin all her life, although she has struggled to maintain her weight since going through puberty, and since she is a salsa instructor, she has to remain fit. She reports that she feels very guilty if she consumes fried foods during the day, but that is the way her mom primarily cooks. She feels awful telling her mom to stop cooking that way. She reports that if she consumes too much fried food or junk food, she will run at least 2-3 miles or else force herself to vomit, but all the food does not come out. She reports sometimes if she has a later class, she will not eat dinner or only eat one meal per day. She has tried counting calories, but then she gets so mad at herself for consuming more than 1,200 calories that it causes her to exercise more, which then leads her to feeling exhausted. She indicates she is on no medication but does take a multivitamin when she remembers to. She indicates she has gone from 110 pounds to 125 pounds over five years and wants to be back down to 110 or even less. She also had gone to the doctor, and he was quite concerned with her lab values. She has provided you a 24-hour meal record:
Breakfast:
One 6” corn tortilla
1/2 cup fried beans cooked with peppers, onions, and oil
1/2 cup rice
One cup no-sugar-added orange juice
Lunch:
One slice of whole-wheat bread
Two slices turkey
One small apple
Dinner:
Two 6” tortillas
Beef with onions and peppers cooked in oil
Tomato, onion, pepper salad (made with oil and lime juice)
Two cups of rice
Height: 5’2”
Weight: 117 pounds (based on your scale in the office)
*See attached labs*
1. Documentation needs to be completed at each nutrition counseling session. What information needs to be documented and kept in Josephine’s medical record?
1. Can we provide Josephine’s health and nutrition information to another health professional? Why or Why not? When is her permission required? When is it not required? (Support your response with academic citations.)
3. In order for Josephine to continue to follow up, how do we address payment and reimbursement? How will you handle it if she has insurance? If she does not have insurance? (Support your response with academic citations.)
4. What motivational techniques would you use to motivate Josephine to continue making progress? (Support your response with academic citations.)
5. It is important to ensure Josephine is progressing through each counseling session. Answer the following questions regarding Josephine’s progress:
a. How often would you schedule follow-up sessions with Josephine, and why?
b. What type of information would you like to collect at the follow-up appointments?
c. How would you assess her previously set goals? How would you modify her treatment based on her progress?
d. Identify any obstacles which could impede her success at achieving these goals.
e. How would you help her get beyond these obstacles?