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Nutrition
KEY POINTS:
Obtaining a Nutrition History
1. Identify dietary patterns and nutritional risk factors. A detailed
nutrition history can uncover excessive calorie intake, poor
macronutrient balance, and poor dietary composition, all of
which contribute to obesity and related diseases.
2. Gather detailed behavioral and contextual information. Assess
why, when, where, and how patients eat, not just what they
eat. Include behaviors such as emotional eating, convenience
eating, rapid eating pace, night eating, snacking, and eating
environment (e.g., television meals vs. family table).
3. Assess meal patterns and intake quantitatively. Use validated
tools such as a 24-hour recall (preferably 72 hours, including
a weekend day), food diaries (over three to seven days), or
smartphone app-based trackers to estimate caloric intake,
macronutrient intake, and diet quality.
4. Explore sociocultural and environmental influences. Assess food
availability, cultural norms, meal preparation responsibilities, and
whether patients experience food insecurity or live in a low-access
environment (food desert). These social determinants significantly
affect dietary habits and the feasibility of interventions.
5. Include beverages and supplements in the assessment.
Evaluate intake of sweetened beverages, alcohol, and other
liquid calories, which can be significant. Document use of
vitamin and mineral supplements and note potential gaps
(e.g., calcium, vitamins D and B12), especially in patients who
have undergone bariatric surgery.
6. Be aware of red flags and comorbid conditions. Red flags include
unintentional weight loss, very low-calorie intake without weight
loss, suspected eating disorders, physical signs of nutrient
deficiency, or adherence to restrictive diets. These may require
laboratory evaluation or specialist referral.
7. Translate findings into actionable, patient-centered goals.
Document findings clearly using a structured format (e.g., total
daily calories, protein intake, servings of fruits and vegetables,
snacking patterns). Provide feedback that empowers change
without stigma or guilt.
