Len Howard is a 48-year old male executive in a Fortune 500 company. In a recent physical exam, he was 5’11” tall and weighed 175 Lb. His serum cholesterol was 290 (desirable less than 200 mg/dL) with HDL of 40 (desirable 40 mg/dL or higher) and LDL of 160 (Desirable less than 130 mg/dL.) His family history revealed that his father and older brother both died of heart disease. His wife is employed as an attorney, and they have a 15-year old son. 

Nutritionist: “You mentioned that the doctor wants you to try modifying your diet. Let’s talk about what you are eating now. Then we can identify what you are eating that is OK and what if any, changes you may be willing to make.” 

Mr. Howard’s food intake revealed the following: 

Breakfast: Orange juice, bacon, two slices to toast with peanut butter, and coffee. 

Mid-AM Snack: Coffee and doughnut. 

Lunch: Beef sandwich or bacon cheeseburger, French fries, and cola. 

Dinner: 8 oz. steak, baked potato with butter and sour cream, green vegetable, salad with blue cheese dressing, cookies, and wine. 

Evening snack: Beer and pretzels. 


1. What is Mr. Howard eating that is desirable and that you can encourage him to continue doing? (Foods reduced in cholesterol and saturated fatty acids) 

2. What Stage of Change (SOC) is Mr. Howard in? 

3. What processes of change are appropriate for Mr. Howard’s SOC? 

4. What are some possible short-term goals for change for Mr. Howard to consider with you? 

5. How would you ask Mr. Howard to assess the importance of a choice of goals? 

6. How would you discuss any obstacles Mr. Howard sees to reaching the goals? 

7. What are some possible steps Mr. Howard could take to reach his goals? What key discussion points would you identify? 

8. What type of follow-up would you recommend with Mr. Howard? 

9. What would be a potential nutrition assessment for Mr. Howard? How would you express the potential nutrition assessment using the eNCPT? 

10. What would be a potential nutrition diagnosis for Mr. Howard? How would you express the potential nutrition assessment using the eNCPT? Write a PES statement for Mr. Howard. 

11. What would be a potential nutrition intervention for Mr. Howard? How would you express the potential nutrition assessment using the eNCPT? 

12. What would be a potential nutrition monitoring and evaluation plan for Mr. Howard? How would you express this using the eNCPT? 

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