Ch 24: Programming: Putting It All Together Flashcards
Putting it all together
Determine, Align, Individualize, Monitor and Evaluate
Formally defined as the action or process of scheduling something. In the context of nutrition coaching, it is the process or scheduling of a nutrition plan in which the plan is set into motion to achieve a specific goal.
Programming
The practical application in which a nutrition coach summarizes the scientific principles of nutrition.
Programming
Programming can be achieved by employing seven defined, but integrated steps:
- Set a goal.
- Determine the total daily energy requirements adjusted for the goal.
- Set the protein macronutrient target.
- Set the fat macronutrient target.
- Set the carbohydrate macronutrient target.
- Individualize and convert numbers to food and habits.
- Monitor, evaluate, and adjust.
What clearly defines a logical order of progression as well as a hierarchy of what to prioritize?
The seven-step process
First step in the programming process
Set a Goal
Define the end outcome for the program.
In the context of nutrition coaching, the outcome is what?
Body composition or exercise-related goal
Goals can be categorized into one of the following types:
Weight (fat) loss, weight (muscle) gain, a combination of fat loss and muscle gain (body recomposition), or improved exercise (sport) performance
A large percentage of clients who seek out nutrition coaching have ____________as their primary goal or a part of their primary goal.
Weight (fat) loss
While some people may set weight-loss goals based on previous body weight or an arbitrary number:
A Nutrition Coach must understand what thresholds and targets can improve client health while still being feasible to achieve
According to most research in people who are overweight or obese, weight loss of ______ can substantially improve an individual’s health and reduce their risk of many chronic diseases (e.g., diabetes and cardiovascular disease).
10%
A 1-kilogram (2.2-pound) reduction in weight can reduce the relative risk of developing diabetes by ___________________
16%
Well-researched rates of weight loss that are realistic and backed by science
This translates to roughly 1 to 2 pounds (0.4 to 0.9 kilogram) of weight loss per week.
Which approach gets implemented often depends on:
The situation, end goal, and weighing the pros and cons of each approach
Two main things to consider when setting a calorie deficit for an individual:
The total amount of weight loss desired and the time frame.
An upper threshold of _______ weight loss per week should be set for almost all clients.
1%
Calorie reductions smaller than about ___________ are not very effective
250 kcals per day
An untrained or novice resistance trainees, a realistic increase in body weight should be roughly
0.5 to 1.0% per month (1-2 lbs per month)
Losing body fat while concurrently increasing lean mass is a goal that is often referred to as:
Body recomposition
Nutrition Coaches should encourage weight-loss clients to:
Begin or maintain an appropriate resistance-training regimen to help preserve lean body mass (i.e., muscle) while in a negative energy balance.
How clients can lose fat and preserve or gain some muscle simultaneously
To do so simply requires adequate protein intake, resistance training, and a moderate calorie deficit. But it is important to note, the rate of muscle gain while in a negative energy balance will be slower than if the client was in a calorie surplus.
Division of a training program into smaller, progressive stages.
Periodization
Effects that directly interfere with adaptations of specific training modalities.
Interfering Effects
Exercise training programs must be tailored to the:
Athlete’s needs, goals, and abilities.
Programming Step 1
Set a Goal (Weight (fat) loss, weight (muscle) gain, a combination of fat loss and muscle gain (body recomposition), or improved exercise (sport) performance)
Programming Step 2
Calculate the client’s calorie and macronutrient needs
Programming Step 3
Understanding an individual’s Total Daily Energy Expenditure
Determining an individual’s Total Daily Energy Expenditure
Total amount of calories expended in a given day
Three main components:
1. Basal Metabolic Rate (BMR)
2. Thermic Effect of Activity (TEA)
3. Thermic Effect of Food (TEF)
Random acts of movement throughout the day besides structured exercise (e.g., fidgeting, taking a shower, or walking to a parked car), is considered an aspect of TEA
Nonexercise Activity Thermogenesis (NEAT)
The rate at which the body uses energy while at rest to keep vital functions going, such as breathing and keeping warm.
Basal Metabolic Rate (BMR)
The energy expended during all forms of activity.
Thermic Effect of Activity (TEA)
The amount of energy (calories) expended to digest and metabolize food.
Thermic Effect of Food (TEF)
Harris–Benedict Equation
Women: BMR = 447.593 + (9.247 × weight) + (3.098 × height) – (4.330 × age)
Men: BMR = 88.362 + (13.397 × weight) + (4.799 × height) – (5.677 × age)
Harris–Benedict Equation Pros
This equation is simple and easy to use. It does not require data on body composition.
Harris–Benedict Equation Cons
It is the least accurate of the listed equations. It does not account for body composition.
Women: BMR = 9.99 x weight + 6.25 x height – 4.92 x age – 161
Men: BMR = 9.99 x weight + 6.25 x height – 4.92 x age + 5
Mifflin–St. Jeor Equation
Katch–McArdle Equation
BMR = 370 + (21.6 × Lean Body Mass (kg))
Step 1: Weight (kg) × Body fat% = fat mass
Step 2: Weight (kg) – fat mass = lean body mass
BMR = 500 + (22 x Lean Body Mass)
To calculate lean body mass:
Step 1: Weight (kg) × Body fat% = fat mass
Step 2: Weight (kg) – fat mass = lean body mass
Cunningham Equation
Once basal metabolic rate is determined, the next step is to
multiply it by an activity factor
Little or no exercise and a desk job
Sedentary: Activity Factor Adjustment 1.2
Light exercise 1 to 3 days per week
Lightly Active Activity Factor Adjustment 1.375
Moderate exercise 3 to 5 days per week
Moderately Active Activity Factor Adjustment 1.55
Heavy exercise 6 to 7 days per week
Very Active Activity Factor Adjustment 1.725
Very heavy exercise or a physical job or training twice per day
Extremely Active Activity Factor Adjustment 1.9
Protein is critical:
Maintaining lean body mass, regulating hunger, and maintaining overall calorie intake
Individuals looking to maximize muscle growth and training adaptations,
Protein targets of 1.6 to 2.2 grams/kilograms (0.7 to 1.0 gram/pound)
Acceptable Macronutrient Distribution Range (AMDR) of Fat for adults
20 to 35%
Carbohydrate target formula
Carbohydrate target calories = total daily calories – protein calories – fat calories
Carbs for general population and athletes who partake in low-volume training or mostly skill-based training
3 to 5 g/kg/day (1.3 to 2.2 g/lbs/day)
Carbs for athletes who partake in moderate-volume, high-intensity training
5 to 8 g/kg/day (2.2 to 3.6 g/lbs/day)
Moderate-volume, high-intensity training
This can be defined as athletes engaging in 2 to 3 hours of training per day for 5 to 7 days per week.
Athletes who partake in high-volume, endurance-based training
8 to 10 g/kg/day (3.6 to 4.5 g/lbs/day)
Athletes who partake in very-high-volume, endurance-based training
About 12 g/kg/day (5.4 g/lbs/day)
High-volume, endurance-based training
Athletes engaging in 3 to 6 hours of training per day for 5 to 7 days per week.
Very-high-volume, endurance-based training
Athletes engaging in > 6 hours of training per day for 5 to 7 days per week.
Once calorie needs are determined and the macronutrients (i.e., protein, fats, and carbohydrates) are set, the next step is
Individualizing the approach and translating the calorie and macronutrient numbers into foods and habits
The individualization of the approach can be achieved through an initial assessment and discussion to help determine a client’s behavioral style, food preferences, current habits, barriers, and goals and discover their current level of nutrition/food competency.
Quantitative Approaches to fit the client’s individual needs and preferences to maximize adherence to the recommended plan
- Measure and Weigh all foods
- Track all Calories
- Track all Macronutrients
- Keep a Detailed Food Journal
Qualitative Approaches to fit the client’s individual needs and preferences to maximize adherence to the recommended plan
- Drink mostly water over Sugary Drinks
- Eat the Rainbow (Colorful Fruits and Vegetables)
- Opt for Whole Grains over Refined grains and added Sugar
- Replace Saturated Fat with Unsaturated Fat
Between Quantitative and Qualitative Approaches to fit the client’s individual needs and preferences to maximize adherence to the recommended plan
Eat at least 3 servings of Vegetables a day
Eat at least 2 servings of Fruit a day
Eat less than 2300 mg of Sodium/Day
Eat less than 10-11% of Saturated Fat
Level of management
Precision
High-level approach
Macromanagement
Detailed, fine-tuned approach
Micromanagement
Observe and check the progress or quality of something over a period of time; keep under systematic review.
Monitor
The assessment, as systematic and objective as possible, of a planned, ongoing, or completed program that covers its need, design, implementation, impact, efficiency, and sustainability, so as to incorporate lessons learned into the decision-making process about the program.
Evaluate
The last step in the process of programming
Monitor and evaluate
Monitoring involves:
Collecting data from the Nutrition Coach as well as the client
-The focus should be on the process; identify the areas of the process that are working and which ones are not.
There are some aspects of nutrition behaviors to be monitored that are more difficult to measure objectively and require a discussion with clients.
Food beliefs, moods, feelings, and quality of life. Thus, the Nutrition Coach should take a holistic view of monitoring nutrition habits with a client to better understand the factors that can either support or get in the way of being consistent.
Evaluation is:
a combination of assessing the process and specific outcomes
Monitoring and evaluating a client can be broken down into the following steps:
- Conduct a baseline readiness assessment.
- Develop a set of data to monitor and outcomes to evaluate.
- Set guidelines for collecting data and monitoring.
- Set intervals for check-ins and evaluations.
- Gather data and analyze results.
- Evaluate the results with the client.
- Work together to form a plan for the next iteration.
All progress should be measured relative to an individual’s starting point. Can define a client’s starting point and provide valuable information regarding next steps.
Conduct a Baseline Readiness Assessment
Motivational interviewing can also help the Nutrition Coach understand
A client’s food beliefs, identify their current level of readiness and motivation to change, and identify the barriers that might get in the way of adhering to the nutrition plan.
After completing a baseline assessment, the next step is to identify the scope for the:
First round of monitoring and evaluation
- Create a simple list of goals and behaviors to track. The scope should be appropriate for the client’s starting point.
Soft data
Can be based on food habits such as how quickly one eats or how full they feel when they stop eating.
Example Habit-Based Goals
Eat more slowly – put the fork down in between bites. Focus on the food: its taste, texture, and smells.
Eat until you’re approximately 80% full. Once you are about 80% full, stop your meal and allow your body time to adjust to feeling satiated.
Drink at least 8 cups of water per day and aim to stay hydrated throughout the whole day.
Set a new sleeping schedule. Aim for 8 hours each night.
Substitute saturated or trans fats (whole cream, butter, or lard) for unsaturated fats (avocado or olive oil).
Eat at least one serving of lean protein with each meal (e.g., seafood, white-meat poultry, eggs, lean beef, or soy).
Fill half your plate with colorful fruits and vegetables each meal.
Drink primarily calorie-free drinks (e.g., water, black coffee, unflavored iced tea, etc.). Minimize calorie-dense drinks (e.g., soda, juice, or energy drinks).
Take a 5-minute break; avoid sitting for more than 3 hours at a time.
Aim for 150 minutes of moderate aerobic activity per week such as walking or brisk jogging.
Practice destressing techniques (e.g., meditate, unplug from technology for an hour, go for a walk, listen to music, or focus on a fun hobby).
Celebrate your wins and revisit any of these habits you are still having trouble maintaining.
Anticipate high-risk situations, identify triggers, and develop coping/problem-solving strategies for lapses.
Develop a social support network.
Replace negative self-talk (especially during weight-loss plateaus) with constructive and positive outlets (e.g., write down and acknowledge your own accomplishments).
Once the general scope is set, the client and the Nutrition Coach should work together to determine what data will be monitored and what outcomes will be evaluated
This step is important as it is critical that the client and the Nutrition Coach are aligned with the responsibilities of both parties. This serves as the foundation for the next step: setting guidelines for collecting data and monitoring
These guidelines include what data is to be recorded, how often it is to be recorded, which party is responsible for collecting what, and how it is to be recorded
Set Guidelines for Collecting Data and Monitoring
Can serve as positive reinforcement for the guidelines and expectations set and can be referred to in later sessions when reviewing client progress.
. A behavioral contract that is created and signed by both the Nutrition Coach and client
Important for keeping continuity and holding the client and the nutrition coach accountable for maintaining a monitoring and evaluation process.
Set Intervals for Check-Ins and Evaluations
Important for keeping continuity and holding the client and the nutrition coach accountable for maintaining a monitoring and evaluation process
Set Intervals for Check-Ins and Evaluations
The length of these intervals should be determined:
Through a conversation between the client and the Nutrition Coach based on how much support is needed to stay on track
Measures understanding by asking clients to explain in their own words what they need to know or do regarding their nutrition, exercise, or health plan.
Teach-Back Method
Gather, Organize, and Analyze Data
At each interval, the Nutrition Coach should gather all the available data that is being monitored, organize that data, and analyze it. The data analysis should be simple and focus on the most important aspects such as average daily and weekly calorie intake, average daily and weekly calorie surpluses and deficits, and adherence (or lack thereof) to habit-based goals.
Nutrition Coach should also take the analyzed data and package it together in a format that the client can easily understand
Form of pictures, graphs, charts, or written reviews
Conveying data to a client is a critical step in the _________________ process
Communication
Conveying data to a client is a critical step in the communication process
Keep numbers simple. Round to the nearest whole number (e.g., round 156.7 grams to 157 grams or even 160 grams).
Use familiar metrics (e.g., metric versus imperial).
Use verbal qualifiers (e.g., small or great).
Place numbers in context so they are relevant, relatable, and understandable.
Order matters: the first and last numbers presented are most likely to be remembered.
Evaluate the Results With the Client
An excellent opportunity to go over key findings, ask questions to understand how the findings relate to the client’s overall goals, receive questions from the client, highlight areas of success as well as areas that can be improved, assess the feasibility of the current plan, and identify changes that can be made in the next iteration.
An excellent opportunity to go over key findings, ask questions to understand how the findings relate to the client’s overall goals, receive questions from the client, highlight areas of success as well as areas that can be improved, assess the feasibility of the current plan, and identify changes that can be made in the next iteration.
Plan for the next iteration in the monitoring and evaluation process. At this point, the client and the Nutrition Coach should repeat this process beginning at Step 1; perform another assessment (it may be abbreviated this time) and then the process begins again.
