ADIME Note: Weight Management

Pt is a 16-year-old female, competitive gymnast. Pt receiving nutrition education

and counseling 2/2 parents concern over pts eating habits.
Pt has been a gymnast for 10 years. She goes to school from 0800-1030 M-F, and
takes an online class each semester. Pt goes to gymnastics practice from 11001700 M,T,R,F. She has meets on some weekends and will have extended practices
before those events.
Food and Nutrition History:
Pt reports that she wants to make sure she is putting the right stuff in her body. She
reports that she does not have time to eat during practice and gets very hungry.
Breakfast- wakes up at 0645 eats at 0715. Breakfast is eggs, bagel sandwich with
egg and sauted mushrooms, cheese omelet.
Morning snack- none
Lunch- 1050- mom packs and brings when she picks her up to take her to the gym.
Pt eats lunch in car and is usually cheese and salami wrap, apple, peanut butter,
cinnamon almonds, yogurt.
Afternoon snack- none. Pt reports that during practice she has no time to stop and
eat and when she has in the past it has upset her stomach and made it difficult to
perform.
After practice- 1700- pt has 8 ounces of chocolate milk
Dinner- Mom cooks. Pt says family rarely eats out and never has fast food. Dinner is
yellow rice, chicken, spaghetti with meat sauce, pancakes, eggs and sausage, there
is usually a vegetable.
After dinner/before bed- pt has whey protein shake with milk, yogurt and fruit and a
cheese stick. Goes to bed at 2130-2200
Weekends- sleeps late and does not have breakfast.
Fluid- adequate hydration, fills 24 oz. water bottle up repeatedly throughout the day
and at practice
Anthropometrics:
Height- 61 inches
Weight- 125 lbs.
BMI- 23.6, Pt has considerable amount of lean muscle mass and very low
percentage of body fat
Biochemical:
Pt reports no history of HTN, High cholesterol, or any abnormal blood tests
Nutrition Focused Physical Findings:
Pt reports weight fluctuation of 3-4 lbs. No reported N,V,C,D. Able to focus in school
and practice. Pt reports urine is a pale yellow. Pt looks healthy, and is focused and

able to communicate effectively. Skin, hair and nails are excellent. Pt does not
appear fatigued and looks well nourished.
Medical History:
No significant medical history reported.
Nutrition Recommendations:
Energy- Pt has a BMR of 1300 kcals. Based on extremely high activity level and
importance of maintaining high percentage of lean body mass, pt is advised to
consume 2300 kcals per day.
Fluid- increased need, at least 1 ml/kcal, monitor urine color and increase as needed
Carbohydrate- increased need, pt needs to consume 30g of carbohydrates per hour
starting at 1230 while at practice. Pt needs 288g CHO daily. (2300 kcal x .50)/4 =
288
Protein- increased need. Pt should consume 144g protein daily. (2300 kcal x .25)/4
= 144
Nutrition Diagnosis:
Inadequate energy intake related to extreme practice schedule that results in
increased energy requirements as evidenced by pts reported hunger at the end of
the day and reported diet history and lack of meal times.
Inadequate energy intake related to decreased ability to consume sufficient energy
during the day as evidenced by pt reported inability to eat while at practice.
Nutrition Intervention:
Determined kcal needs, provided sample menu and eating pattern. Encouraged
variety in eating habits by adding different fruits and vegetable at typical meal
times. Suggested adding a quick snack like a banana or carrots with ranch dressing
in between breakfast and lunch while in between classes. Discussed how to read
food labels and determine carbohydrate amount. At practice, discussed adding
supplements to increase energy consumption slowly so upset stomach can be
avoided. Pt was shown several different supplementation options including: sport
beans, GU, energy bars, energy biscuits, and Gatorade. Pt was advised to start
eating 30g of carbohydrates every hour of practice. She will start out with one
supplementation and progress slowly to more as she gets used to the practice. Pt
stated she would be open to trying sport beans and Gatorade. She can mix
Gatorade with her water since she is accustomed to drinking from her water bottle
throughout practice. Pt acknowledges understanding and good compliance is
expected.
Monitor and Evaluate:
Weight
Energy level

Pt reported performance