Applying the nutrition care process

Photo Cred: Polina Zimmerman/Pexels

By Kellie Blake, RDN, LD, IFNCP

Creating the tailored nutrition plan involves collecting and analyzing relevant information to determine the most appropriate initial strategy. For nutrition professionals, this framework is called the nutrition care process and includes the following steps:

• Nutrition assessment and reassessment
• Nutrition diagnosis
• Nutrition intervention
• Nutrition monitoring and evaluation

In my practice, the nutrition care process for tailored nutrition involves gathering and evaluating all necessary information, including:

• Food and nutrition history
• Lab data and medical testing
• Anthropometric measurements
• Nutrition-focused physical exam
• Client and family history

Once I have this information, I can appropriately diagnose or pinpoint the specific nutritionrelated

problem we need to target, such as issues with macro- or micronutrient intake, digestion, or assimilation. From there, I can design an intervention, a tailored nutrition plan, which will be monitored, reevaluated, and modified based on the progress of the patient.

The nutrition assessment starts with gathering and evaluating helpful information. A detailed nutrition intake form can provide information regarding the patient and their nutrient intake, as well as provide helpful clues about their digestion and absorption. This initial form will provide the practitioner with most of the information needed for nutrition assessment.

A proper nutrition intake form includes:

• Client goals and concerns
• Allergy information
• Pertinent family history
• Detailed medical history
• Birth history
• Medications and supplements currently and previously used
• Nutrition history and food diary
• Lifestyle
• Environment
• Readiness to change
• Digestive health
• Symptom questionnaire

The next step is to perform a nutrition-focused physical exam, if possible. This step is not required but can provide additional information for creating a tailored nutrition plan and can be especially helpful when there is a lack of functional lab testing available.

When performing the nutrition-focused physical exam, observe the patient for signs and symptoms of inflammation, oxidative stress, metabolic or endocrine dysfunction, overall cardiovascular risk, food sensitivities, fungal or bacterial overgrowth, nutrient deficiency, thyroid dysfunction, parasites, dysbiosis, hydration status, sleep apnea, and hormone issues.

The nutrition-focused physical exam addresses all areas of the body including body composition, musculoskeletal function, and observing skin, neck, hair, mouth, eyes, and nails.

During the physical exam, I ask specific questions about the patient, but also visually inspect and utilize palpation to observe for physical signs of specific nutrient deficiencies, malnutrition, and chronic disease, such as overall strength, weight and fat distribution, acne, hair loss, ridged or split nails, or vision changes.

The nutrition-focused physical exam is not used as a stand-alone tool. It can help confirm the suspected nutrition-related diagnosis and contribute to the development of the tailored nutrition plan.

To create a nutrition diagnosis, I evaluate the information from the nutrition assessment process. I combine the information from the nutrition intake form, my patient interview, and the nutrition-focused physical exam to determine what nutrition-related issues we will want to target with the nutrition plan.

For example, if my client is experiencing bloating after meals, alternating between diarrhea and constipation, and unexplained weight gain, my nutrition diagnosis would be dysbiosis.

By the time patients reach my office, they are typically overwhelmed. So, when communicating a nutrition diagnosis to the patient, I am mindful of providing information in an empowering way. I remain positive and remind patients that the body naturally wants to heal itself, and our work together will remove the roadblocks that have been preventing optimal health. When patients understand how much control they have relative to their diagnosis, they are more engaged and successful.