Assignment
Imagine yourself in the role of a nutrition counselor, and Josephine is your client. Josephine is a 20-year-old female who presents with a purging disorder, an "Other Specified Feeding or Eating Disorder" (OSFED). She currently teaches salsa lessons at the community college and is in her last semester of college. She reports she is living at home, and the food her mother prepares is not the healthiest because her mom is from Honduras and her father is from Guatemala, so the food is prepared differently. She indicates she has been thin all her life, although she has struggled to maintain her weight since going through puberty, and since she is a salsa instructor, she has to remain fit. She reports that she feels very guilty if she consumes fried foods during the day, but that is the way her mom primarily cooks. She feels awful telling her mom to stop cooking that way. She reports that if she consumes too much fried food or junk food, she will run at least 2-3 miles or else force herself to vomit, but all the food does not come out. She reports sometimes if she has a later class, she will not eat dinner or only eat one meal per day. She has tried counting calories, but then she gets so mad at herself for consuming more than 1,200 calories that it causes her to exercise more, which then leads her to feeling exhausted. She indicates she is on no medication but does take a multivitamin when she remembers to. She indicates she has gone from 110 pounds to 125 pounds over five years and wants to be back down to 110 or even less. She also had gone to the doctor, and he was quite concerned with her lab values. She has provided you a 24-hour meal record:
Breakfast:
One 6" corn tortilla
½ cup fried beans cooked with peppers, onions, and oil
½ cup rice
One cup no-sugar-added orange juice
Lunch:
One slice of whole-wheat bread
Two slices turkey
One small apple
Dinner:
Two 6" tortillas
Beef with onions and peppers cooked in oil
Tomato, onion, pepper salad (made with oil and lime juice)
Two cups of rice
Height: 5'2"
Weight: 117 pounds (based on your scale in the office)
Labs:
Test
Result
Reference Units
Albumin (visceral protein stores)
3.3 g/dL
3.5-4.8 g/dL
Sodium
133 mEq/L
136-145 mEq/L
Potassium
3.8 mEq/L
3.5-5.2 mEq/L
Iron
0.4 mg/dL
0.6-1.1 mg/dL
Vitamin B12
185 pg/mL
200-835 pg/mL
Task
A. What is Josephine's culture? Specifically, in terms of family roles and social customs, including traditional foods and the expectations placed on Josephine related to them.
B. How does her culture affect her food choices? (Include multiple examples to support your response.)
C. How would you need to change your counseling strategies to establish a trusting relationship with Josephine? (Include multiple academic citations to support the strategies you choose.)
D. What multicultural communication skills would you use to have a successful nutrition counseling session? (Include multiple academic citations to support the skills you select.)