HighLowQualityCounseling/transcripts/high_076

T:	good afternoon miss Joe knobbly my name is
C:	afternoon
T:	my name is Jessamine all knobbly and I will be leading you through our nutrition and education and counselling meeting today
C:	okay
T:	just a little bit about myself I am a Nutrition and Dietetics student at Loma Linda University and we'll be sitting for my Rd exam next June
C:	fantastic
T:	so I just want tell you know I got into this field because I just really wanted to enhance and improve people's health through making advantageous dietary choices so
C:	that's great
T:	before we get started would you like a bottle of water
C:	I'd love to have a bunch of water
T:	okay
C:	thank you very much sure yeah can I start drinking now
T:	yes go for it so in today's session I would just like to hear about some of your personal goals why you came to the session today obstacles you may be facing in regards to nutrition and just figure out some ways to overcome challenges that you may be facing
C:	okay well number one I'm really really happy to have this opportunity to sit down with you and discuss my really horrible eating habits especially by you know recently I have been actually struggling with wanting to lose the weight I would say for about a good six seven months now and all that I have seen so far is that I've been basically actually basically fluctuating between 199 and 206 sometimes even 208 the struggle today has been the frustration level of when I get on this okay I'm going to get on this quote-unquote diet and I'm going to lose the weight something amazing happens I actually end up painting I'm tired in the morning I'm stressed because we started this whole new business that we have here and I'm totally out of control I feel that I'm totally out of control when it comes to eating I think a lot of it has to do with not eating quote/unquote properly or systematically
T:	okay so for you I just threw a lot at me so I'd like to go back and recap some of the things that you were saying to make sure that I'm understanding everything clearly
C:	okay
T:	so in January 2010 you started a meal plan that was very strict and you were able to maintain it for a few years
C:	no few months
T:	few months yes you think a few months and then you started to travel and you know kind of things kind of went a little bit astray from there
C:	yes
T:	you went from this strict dieting all-or-nothing kind of plan do not really knowing how to make food for yourself or compose a meal for yourself because you were
C:	let me was you know it's interesting you say that because that meal plan that I was on that diet plan yeah what's called a no decision
T:	yes it's a
C:	no decision diet which means you don't have to make any decisions about anything this is the prescription and you live with that prescription you'd be alright anyone else I kind of denied it
T:	so you almost kind of missed out on the education portion of how to eat when you're on your own
C:	yes
T:	which is what in the long term we want to achieve is for you to be able to make healthy food choices when someone isn't there to tell you what to do you're able to critically think for yourself and regardless the nutrition
C:	yeah
T:	so some other things that you mentioned was that you're just feeling frustrated and kind of out of control in regards to your weight-loss initiatives which I can which is very it seems very frustrating if you want to be losing weight and you're not not seeing it and then you said that you were tend to be eating more so those are all very frustrating things and not and then you also said that during your day you're not really eating consistently
C:	at all
T:	you're kind of all over the place and kind of looking for more of you know consistent meal plan day in which you're not you know starving and then overeating later
C:	I do the kind of like keeping it's like I wish I had one person walking behind me this fear you whatever that says okay mealtime here it is it was like preparing it here it is you know so that because I just eat such a stressful and such a work living environment
T:	let's talk about where you get most of your meals from
C:	I would literally stop at the supermarket or I would stop at a 7-eleven or I would stop at a couple of times I didn't know a lot of times i stopped at Dunkin Donuts right that pick up the donuts or at the other daughter shop I would pick up because it's fast a lot of times I'm eating out and it's not you know the best thing in the world
T:	okay um so I'm hearing that you get most of your meals from outside of the home
C:	yes
T:	and not typically cooking meals and kind of go for those more convenience convenience meals that's easy yes so how would you feel about going over some tips for when you're dining out that if that's if you're very busy and like that's the option that you're doing right now I'm just making some little tweaks because cooking at home may not be an option for you at this moment
C:	that's very true probably I would say yes
T:	so making little changes
C:	yes in regards to the restaurant is the way everything changes
T:	yes are some some tips that you can implement when you're at the restaurant
C:	okay
T:	so some of the things that I would like to talk about so when you're ordering food from a restaurant you want to stay away from words such as like fried or just like also deep fried and kind of go for those words like royal bake and steam
C:	okay
T:	so recently you told me that you went to a restaurant and I have the menu printed out here and I would give you a copy of that
C:	yes
T:	and and you told me that you ordered the New York strip steak
C:	yes
T:	and you had bread and butter for your meal
C:	yes I do
T:	so just looking at the options here we do have a fresh fish option at the top
C:	yes
T:	and it says it's simply grilled with olive oil or you could get it pan-seared baked or blackened with lemon shallot butter
C:	mm-hm
T:	so I would probably say maybe to stay away from the lemon shallot butter noise and maybe steer towards that simply grilled with olive oil or the maybe the baked or
C:	a boy in this use
T:	you could do the pan serve but the other ones are better option
C:	okay
T:	so that's um -
C:	I would have enjoyed the tilapia for exam
T:	okay so
C:	that's what I like to eat that they were Chilean sea bass I would have enjoyed that too
T:	so that's an opportunity that you would be
C:	yeah
T:	you enjoy billing to go change
C:	yeah
T:	so going for those terms and maybe doing like maybe a fish option every once in a while as opposed to doing a steak
C:	yes
T:	okay some other tips so when you're ordering if you want to order a salad instead of ordering the salad and getting kind of like a Caesar dressing or something like that they typically kind of put a lot of dressing on salads so maybe ordering it on the side is a better option because then you can be in control of how much you would like to add on to the salad
C:	okay
T:	and typically going for maybe like a balsamic dressing is good or you could do a balsamic and olive oil dressing
C:	mm-hmm
T:	typically most restaurants will have that option
C:	yes and I like both stomach vinaigrette
T:	so also in regards to restaurants portion sizes are typically very large and you had mentioned earlier that you know sometimes you just don't know when to stop eating or you tip you think you're hungrier than you are you just eat a lot at once
C:	yes
T:	when you give that example with the bread
C:	yes
T:	so a good tip is to kind of ask for a to-go box in the beginning when you get to the restaurant
C:	mm-hmm
T:	after your meal comes and just put half of the food in the box and you don't open the box can't get home it's kind of bang for your buck too right because then you can either other real later
C:	yes
T:	and you could if you do choose a healthy option you can take it to work the next day and you'll have a lunch option for you here at the office
C:	yes
T:	um also when it comes to salads you really don't so here they have the chopped spinach salad for example there's bacon egg radishes mushrooms and warm bacon dressing just because a menu item has all these things included does not mean that you have to get it with all those things in it
C:	okay
T:	so you can easily tell them oh can I have the chopped chicken it's chopped spinner salad without the bacon
C:	right I don't like bacon
T:	so that is something that you could ask for for that side because I mean spinach is great mushrooms are great radishes are great egg is great you can always take out egg whites I mean the egg yolk if you don't want the egg yolk or anything like that so a lot of restaurants I think analogies are accommodating because they want to have your certainty they want to have your business
C:	yes
T:	so they're gonna try their best to make the customer happy
C:	yes
T:	so for me personally I often ask for changes in my in my orders unless they specifically specified please do not make changes on to the order or we can't make a change for this order I typically change majority of my orders
C:	hmm
T:	because the foods that you eat or the foods that are commercially made are not necessarily the healthiest
C:	yes
T:	they're made to appease the palate
C:	right
T:	so they usually have lots of fat and you know sugar and sodium and those kinds of things added to it to appeal to a wider variety of individuals
C:	mm-hmm
T:	I have a little handout here so we can talk about some like portion sizes
C:	okay
T:	so a fist would be considered like a cup of rice or pasta or fruits or vegetables it's about the size of your fist is one serving
C:	now that's cooked rice oh
T:	yes good right the palm of your hand is about three ounces so that would be for fish meat or poultry that's about the size some people say like a deck of cards it's about 4 ounces
C:	hmm
T:	it's around there and then if you're gonna have nuts of reasons a handful is about 1 ounce there's like a little handful so one thumb would be one ounce of hard cheese or peanut butter and you said
C:	Wow I love cheese you know
T:	and then for your thumb is a a teaspoon of our thumb tip is a tea spoon of cooking oil or margarine or butter and sugar
C:	teaspoon
T:	as a teaspoon why don't you try and start setting some goals for you in regards to some food we do
C:	okay
T:	of what would work
C:	that seem so you go one
T:	so what is what is one goal
C:	that you want you would like to accomplish for what's the eating out that I want to accomplish for eating out
T:	yeah so would you um what a goal be that you want to choose grilled options
C:	well I see
T:	what you mean okay are you willing to do that choose grilled options
C:	you know it's sometimes that would be a goal
T:	so how do you feel about journaling
C:	hate was difficult to do but it was very exciting
T:	mm-hmm
C:	because it is making me it helps me actually meet that objective
T:	okay so that seems like something that we could
C:	yeah I usually get up with you already six o'clock in the morning
T:	would you have time to journal that
C:	yeah I can make the time for that
T:	okay so um how many of these a week would you say you could draw
C:	I can technically journal every day
T:	okay so why don't you give a range of times so why don't we say four to seven times a week in the mornings for we can say until our next session so we can go you can go back and recap how the journaling is going for you
C:	what am i generally I'm gonna do it in the morning
T:	generally how you're feeling physically maybe the food reflect on the food choices that you had made the day before maybe set some you said you like setting little objectives maybe little mini goals for yourself for the day things like that
C:	that is easy for me to choose actually
T:	okay that's great so why don't we just make sure we're doing that let's say seventy-five percent of the time you're eating out
C:	okay that is really very doable for me
T:	okay
C:	because I do it every lunchtime when I go that's exactly
T:	what I do we try and good ideas living by kind of like an 8020 percent rule so eighty percent of the time you're making healthy choices twenty percent of the time you can kind of you know feel like you're not as restricted because it seemed like in the past being on a very strict diet doesn't work in the long run because that's not how life works
C:	yeah
T:	and things are thrown at you and you have to be a little bit valuable to your different situation
C:	yes
T:	so those are some good goals now I would like to talk a little bit maybe up some physical activity
C:	yes so I would love to be accused might cost me too much money
T:	yes so I'm understand that you do want to become more physically active and you've had experience in the past being physically active what do you feel has prevented you from from being physically active is it time is it being tired
C:	it's actually both time being tired
T:	okay you know what kinds of physical activity do you enjoy doing if you were to do physical activity what do you like doing
C:	I would I'm looking
T:	biking swimming activities
C:	I love swimming
T:	okay
C:	I would I don't mind actually gonna get a treadmill on the place I don't I do enjoy those things because they do we find me when I do it I don't just like I'm tired
T:	you start that's difficult he's very different getting there
C:	yes yes
T:	okay so um okay so starting is difficult but just remember that any little changes you're making are are good even if it's going to the gym for just a little bit in 20 or 15 20 minutes or just walking outside of your house and you know after work or in the morning around the lunch break just going outside getting some fresh air how do you feel about maybe parking further
C:	I do that
T:	okay
C:	you know it's interesting but I don't do it all the time
T:	so maybe we'd like to set a goal for that so what about well what what seems good for you how often do you want to do it every time
C:	what
T:	would you like to park far
C:	actually get all the time for a while I did and then I stopped I'm gonna park like the closest I can
T:	so even that alone will give you a little bit more
C:	that's physical activity
T:	exercise so maybe parking I don't know an exact distance but parking further away if you're going to the grocery store if you're going in and out of places just walking more in general
C:	yes but I get the idea though
T:	typically once you start something you kind of like and start seeing results
C:	yes
T:	so that's where your motivation
C:	yes yes
T:	so your motivation lies and seeing results
C:	yes yes
T:	okay so then something to remember is that results don't come overnight and that's hard
C:	yes
T:	to have to stick to something and constantly remembering that and maybe that's something you could write about in your journaling too I'm saying that results literally writing results don't happen overnight
C:	mm-hmm
T:	because if you do stick to a plan over time you will see results yes we exciting for you
C:	yes
T:	I'm the greatest so maybe getting up in the morning and going on the treadmill how often would you be willing to do that sure we
C:	you know
T:	it's realistic a week realistically
C:	I mean I would love to do is float accent
T:	four times a week so for how long do you think you can even go on
C:	I always wanted to be on the treadmill for about 60 minutes
T:	60
C:	yeah it feels good when I'm on threatening for 60 minutes
T:	do you think that would be realistic for your schedule and now that we're saying that we're gonna be journal
C:	you start out you mean you know
T:	okay so why don't we start trying with 20 minutes
C:	okay
T:	so for 15 or 10 minutes or 50 Matt what works best for your schedule
C:	well
T:	what is realistic
C:	I have to tell you that I have tried the 10 and 15 minutes and it doesn't do much at all it doesn't feel like I have done much you know I mean
T:	over time
C:	I guess it depends on how I'm using the treadmill
T:	mm-hmm and over time it will help but you also have to couple it with your with I don't is
C:	I put down 20 minutes
T:	20 minutes
C:	doctor for 20 minutes or day for four days a week
T:	mm-hmm
C:	excuse me on the treadmill and I can start without doing the incline or anything just to get myself back into doing it
T:	okay
C:	getting used to it
T:	yeah it's going through the motions so yeah well it becomes kind of second nature
C:	right right
T:	they say it takes about like 27 or 30 somewhere around their days to develop a habit
C:	I really that's interesting point
T:	I'll have to get you the exact number later but yeah so for it to start feeling second nature so it seems like you are really you want to make you're you're preparing to make the changes right so
C:	yes
T:	you know you know that you want to make the changes and you feel ready to make you feel ready to make these changes
C:	I actually do yes I mean I'm was really really happy when you approached me to have this this meeting I really was and that's why I was sharing with you the details
T:	mhm
C:	it's almost like going to confession and because because I don't feel good about where I am I really don't
T:	maybe one last thing I can mention right now
C:	um
T:	his water
C:	is why it's I like water and I it's easy for me to drink water is because my throat got used to actually taking in that much water it's not a five-piece to be a fight than to begin
T:	yeah
C:	you know
T:	that's like me to drinking water for me is a struggle and I have to make myself do it but I know that I'll feel rejuvenated and I'll my body will function better and let my metabolic processes happen like they should and get my food and digestive system going so they're very I mean we're made up of mostly water so your thought you brought he needs that
C:	yes
T:	and just keeps you more alert when you're dehydrated do typically more sluggish and you're less more likely to make poor nutrition decisions
C:	yes yeah
T:	so just drinking water so why don't we you said you've done it in the past right how do you feel about drinking five bottles
C:	I honestly would not mind at all especially if I started exercising I think
T:	so you know it's really cool as they have apps now
C:	though
T:	that you can track how much water you're drinking I'll have to drop
C:	and you give them out to anyone that for you
T:	mmm-hmm yeah and you can track how much water you're drinking out of there and there's other web sites or apps like MyFitnessPal that you can track what you're eating and it will track all the calories and things like that for your day so why don't we go over um why don't we recap some of the goals so I just wanted me to say your understanding you know what we went through and some things that we talked about
C:	okay let me tell you what they are
T:	yes please
C:	okay so the first thing he said is how about if I did some journaling and he said to do it between four and seven times per week in the morning and then I should actually indicate also in my journaling how I feel also he said to reflect on the food choices that I made for the day the day before and that should be part of my journaling
T:	yes you should be noting some goals for the rest of the day so I want to drink five remember to drink five bottles of water
C:	and I last part of my journal
T:	things like that just was kind of like reminders for yourself
C:	okay the second thing there were five things all together the second thing was we talked about restaurants because I eat a lot
T:	mm-hmm
C:	and he said that I really should choose always put in my mind that I should be choosing Royal Baker steamed 70% of the time but if I go with the 8020 rule it would be good I can do 82% of the time I should be doing good choice since 20% of time it can't be bad choices that's okay because many minutes so that's basically what I remember you say
T:	well I also want to reiterate that it's you know there's no good food and bad food right there's no such thing as good food bad food that's when we we come to pick like portion sizes right
C:	Oh
T:	so food is food
C:	yes
T:	but we want to have more you know plant-based foods and we meats and low-fat dairy and whole grains and things like that
C:	um
T:	and fruits and things because of all the health benefits that they have
C:	yeah
T:	and then we want to you know for sweets and other other treats and desserts we want to keep them as treats and desserts and by doing by keeping a portion the size small we can also you know continue our goal of weight loss
C:	okay
T:	because we don't want to you know deprive you and then all of a sudden oh I want to binge eat all this food
C:	right
T:	so and you know there's you know events and parties and things like that that you kind of need to be you know okay with you know living a little bit
C:	yes
T:	so that's it
C:	okay that's very good points and I noted those things the third thing is the physical activity he said that I should really begin if I do like and enjoy using the treadmill for example I ought to consider maybe 20 minutes to start every 29 to 30 days chances are you will develop a habit
T:	I don't remember the exact timeframe but it's somewhere around there
C:	okay
T:	maybe keep it as a goal just to get there just to get to that
C:	oh yes yes
T:	mm-hmm
C:	even if you go into the office
T:	yeah
C:	so that's very logic number five the fifth thing you talked about is which was more of an educational piece and you said it was all about calories and you said that what I should be considering is taking in about what would be 500 less calories per day and if I did that it would equate a loss of one pound per week
T:	yes
C:	and and don't forget to increase your water intake by basically take the five bottles that I basic I was saying that I used to do so start drinking more water and drink water is because carbohydrates attached themselves to water and it is a good idea to reduce carbohydrates are important for the body but at the same time a lower intake of the carbohydrates would probably be helpful in weight loss
T:	well it will have to be helpful with water I mean it will result in water weight loss but that's not really fat loss so that removes water weight will come back when you drink a bunch of water again so that's not really the weight loss were looking for we want fat loss
C:	okay
T:	you want a decrease in fat and increase in lean mass
C:	so I mean how are you gonna lose the fat the yeah the fat loss
T:	through your diet and just exercising well and
C:	better choices you write coochie which is basically I always think Roy big steam right
T:	yes because three 3