Nick is a 34 year old male who is 73" tall, weighs 185 pounds, and has a BMI of 23. Nick played football in high school and college, but after graduation he began a Master's degree that has him sitting in class much of the day. To help relieve stress, he rides a stationary bike between classes for up to an hour every day.  During the week he carefully watches his food intake to help him keep fit.   Nick's girlfriend Amy is 31 years old 67" tall, weighs 110 pounds and has a BMI of 17. She was a dance major in college and continues to perform with a local dance company. She practices and performs several hours per day, and strictly manages her weight. They often go to dinner on Saturday nights at an "all you can eat buffet". Nick enjoys a "cheat meal" of 2 or 3 plates of dinner and dessert while Amy picks at her food and states she can't eat much or she will get fat.

1. Which statement most accurately summarizes the issue or problem presented in this case study?

A. Nick and Amy are healthy young adults who should live long and healthy lives
B. Nick is considered obese but Amy is at a healthy weight
C. Nick is at a healthy weight but Amy is under weight and possibly showing signs of disordered eating

D. Both Nick and Amy are at unhealthy weights based on their BMI and maybe malnourished

2. What position would be the most reasonable one to take considering the problem and information presented in this scenario?

A. Nick should consider having a gastric bypass surgery
B. Amy should consult with a dietitian that specializes in eating disorders in athletes
C. Nick should keep a 3-day diet and exercise log, and consult with a dietitian for advice
D. They should research diet, exercise and health on the internet

3. What information will be most helpful in resolving the problem in this case study?

A. Results of a cardiac stress test for Nick
B. Waist circumference for both Amy and Nick
C. Daily weights and food records for Nick
D. Bone density test and body fat analysis for Amy

4. Taking into account the impact that a decision will have, what should be the recommended course of action?

A. Nick and Amy are still young so they can eat whatever they want
B. Since Amy is a dancer with a very low BMI, she should consider adding 300-500 nutrient dense calories to her diet per day
C. Amy should eat a variety of foods from all food groups but, decrease her dietary intake by approximately 500-750 calories per day
D. Nick should follow a 1000 calorie, very low carbohydrate diet

CASE #2

Wilma is 56 years old, and works long hours as a secretary. She brings canned soup, or ham & cheese sandwiches from home for lunch. She stops at the vending machine to buy chips, soda and candy to snack on throughout the day. When she gets home, she has a glass of wine, and then she and her husband usually go to their favorite pub for burgers and fries. On her days off, Wilma gets together with her friends for coffee and dessert. Lately, she has been suffering from constipation, but does not think it's serious enough to go to the doctor.

1. Which statement most accurately summarizes the issue or problem presented in this case study?

A. Wilma should not be concerned: constipation is not unusual.
B. Wilma probably does not need to change her dietary habits.
C. Wilma may be getting too much Vitamin A.
D. Wilma's lifestyle and food choices put her at risk for colon cancer.

2. What position would be the most reasonable one to take considering the problem and information presented in this scenario?

A. Wilma does not need to do anything, since she has been healthy so far
B. She should see his doctor for a physical exam and a colonoscopy
C. She should cut down on her work hours to rest.
D. She should call her doctor to ask for a laxative.

3. Taking into account the impact that a decision will have, what should be the recommended course of action?

A. Wilma should get more exercise
B. Wilma should eat a diet higher in fiber from fruits, vegetables and whole grains
C. Wilma should eat a diet lower in fat, sugar, and alcohol
D. All of the above

CASE #3

Suzanne is an attorney with 3 young children.  She is 5' 7", weighs 249 pounds, and her BMI is 39.  She and her husband work long stressful hours.  They spend nearly every afternoon and evening taking their kids to practices, games, and getting homework done.  Suzanne typically skips breakfast, and only has time to grab a quick snack at the office cafeteria around 2:00 p.m. She drinks 2 or 3 cans of coke during the day for a caffeine "pick-me-up" between clients.  For simplicity, she picks up pizza, burgers, or Chinese take-out for her family every night on the way home from work.  By 10 p.m. she drops onto the couch with her favorite ice cream to "treat" herself after a long day.

1. Which statement most accurately summarizes the issue or problem presented in this case study?

A. Suzanne should not be concerned: for the next few years her busy lifestyle will leave no time for healthy eating
B. Suzanne can afford to eat most of her calories at night since she skips breakfast and lunch

C. Suzanne is obese, and her lifestyle puts her at additional risk for cancer, high blood pressure, osteoporosis, and heart disease.

D. Both A. and B.

2. What position would be the most reasonable one to take considering the problem and information presented in this scenario?

A. Suzanne does not need to do anything, since he has been healthy so far
B. She should see her doctor for a physical exam
C. She should cut down on her work hours to rest.
D. She should consider planning ahead for healthier meals during the day, and limiting portions of fast food at night.

3. Taking into account the impact that a decision will have, what should be the recommended course of action?

A. Suzanne should consider losing at least 10% of her current weight.
B. Suzanne should begin a moderate exercise program
C. Suzanne should eat a diet lower in fat and sugar, higher in fiber from fruits, vegetables and whole grains, and try to exercise.
D. All of the above

CASE #4

Laurie is a single mother who works two jobs to support herself and her two young children. She can

usually pay the rent if she is careful not to spend too much on food and necessities during the month.  She does

not have much free time and often makes dinners that are easy to prepare like instant macaroni & cheese and bologna sandwiches. She also chooses the same foods every week since her kids are happiest with foods that are familiar to them. When she wants to treat her kids to a "special" meal, she takes them to McDonalds and lets them choose from the dollar menu.

• Which statement most accurately summarizes the issue or problem presented in this case study?
• Laurie is a hard working mom, and is probably too tired to fix healthier foods for her kids
• Laurie is choosing filling, inexpensive, foods for her kids
• Laurie's situation leads to her to choose fast foods or processed foods, which may lack essential ingredients.
• Laurie's kids can learn to make healthier food choices as they get older.

• What position would be the most reasonable one to take considering the problem and information presented in this scenario?
• Unless Laurie gets financial assistance, there is no way she can improve her family's food choices.
• It is possible for a person who has limited time and finances to eat well if she/he has received nutrition education.
• Laurie should quit one job so she has more time to care for her kids.
• It is always more expensive to eat healthy foods that to eat fast foods.

3. Taking into account the impact that a decision will have, what should be the recommended course of action?

A. Laurie could use the Choose My Plate website to investigate easy, low cost options for adding healthy food options to her family's menu

B. Laurie should depend on the school lunch program to provide all the nutrients her kids need to eat every day.

C. Laurie's kids are still young so they can eat whatever they want as long as their weight remains within normal limits for their ages.

D. There are no changes that need to be made.