Running head: RISK REDUCTION

Risk Reduction
Emily Mortensen
Ferris State University

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Risk Reduction

When health is absent, wisdom cannot reveal itself, art cannot manifest, strength cannot
fight, wealth becomes useless, and intelligence cannot be applied (Balch, 2003, p. xi). This
quote was made famous by the ancient Greek anatomist Herophilus, who is commonly known as
the Father of Anatomy (Bay & Bay, 2010). Health is essential for individuals to live a full and
successful life. The website Sharecare was created by Dr. Mehmet Oz and Jeff Arnold to help
people learn more about their health and what they can do to improve it. One tool that is
available to individuals by this website to help them manage their health is the RealAge test. This
test observes the holistic individual, based on the areas of health, feelings, diet and fitness, and it
will explain to them what aspects of their health they are succeeding with, and what areas they
may need to improve. One client has taken the RealAge test, and a care plan will be created to
determine how she is managing her health (Oz & Arnold, 2015).
Assessment
HO is a twenty-year-old client who has agreed to participate in the Risk Reduction
program. She has completed the RealAge test, and her results show that with the amount of
health management that she does, her true age is 30.3 years old. These results prove that she
needs to take a few more measures in order to live a long, healthy life, but it is not out of reach
(Oz & Arnold, 2015).
Positive Health Practices
HO does take a number of measures to benefit her health, practices that help to make her
younger. The first of which is the fact that she ensures she gets adequate amounts of sleep every
night. This aids her body in getting the rest that it needs so that during the day she will be able to
work in her best mental and physical state (Oz & Arnold, 2015).

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Another positive health practice that HO has is her fitness routine. She ensures that she
gets the amount of exercise that her body requires weekly, and this will help her body to stay
young. Exercise presents an individual with a number of health benefits. It will slim the body,
tone muscles, and make a person feel healthier (Oz & Arnold, 2015). King, et. al. performed a
study in 2009 to determine the full effects of exercise on the body, and they determined that there
is a much greater benefit to exercise than just losing weight. They gathered a group of 58
sedentary overweight and obese individuals who all participated in a 12-week supervised aerobic
exercise intervention. By the end of the program, only half of the participants had lost what they
had predicted, but every participant benefitted from this program. These individuals gained
increases in aerobic capacity, decreased blood pressure, waist circumference, and resting heart
rate. Their moods also seemed to be greatly improved by the end of the study (King, et. al.,
2009). With the benefits that were displayed within just three months of beginning a regular
exercise routine, one could just imagine the benefits that a client would see if they permanently
added exercise to their daily life.
Negative Health Practices
There were numerous items that had presented themselves as practices that HO could
spend some more time focusing on in her RealAge results in order to remain healthy. The first
item is coping with stressful situations and negative events. This client needs to find more
healthy ways to cope with major life-disrupting events in order to protect her mental stability.
She should find others to support her, or turn to her faith to keep her strong in difficult times (Oz
& Arnold, 2015).
A second item that HO would need to focus more on is her diet. She does manage to eat a
healthy breakfast every day, but her test showed that she needs to expand her diet. According to

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these results, she is not getting enough grains, fruit, vegetables, nuts, or fish, and she needs to
limit her junk food and red meat. To remain in good health, it is important that HO eats a wellbalanced diet (Oz & Arnold, 2015).
Analysis
After observing HOs case, two wellness diagnoses that could be made are: Imbalanced
nutrition: Less than body requirements related to ineffective eating habits, and risk for spiritual
distress related to life-disrupting events and stress (Ladwig & Ackley, 2014). These two factors
together can exhaust the human body, and cause her health to decline. In order to remain in good
health, she will need to make a few changes to her daily life. The area of her life that requires the
most focus is her diet, due to the fact that she has failed to meet the requirements for most of the
items on that list. The increased fruit, nuts, and fish in her diet would work together to improve
her cholesterol levels, and if she were to decrease the amount of junk food she consumes, the rate
at which her body ages will begin to decrease rapidly, because all of the empty calories that are
present in these foods contribute to the aging and clogging of arteries. These will both aid in
increasing her quality of life as years pass (Oz & Arnold, 2015).
In discussing the plan with HO about how she is to begin working on improving her diet,
the client displayed that she is aware of her poor eating habits, but she does not feel she is ready
to commit to completely overhaul her current diet for one that is more beneficial to her health.
This mindset places her in the contemplation stage of the Transtheoretical Model. Clients in this
stage are nearly to the point where they would be ready to make large changes in their lives to
improve them, but they do not feel they are able to make that commitment yet (Transtheoretical,
2015).. With a client in this stage of change, a nurse can use the technique of motivational
interviewing to aid her in the progression towards bettering her health. This technique is patient-

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centered and it uses questioning, empathy, and reflective listening in order to make the client
more comfortable with the process of change (Zimmerman, Olsen, & Bosworth, 2000).
Intervention
Malnutrition is a problem that is present all over the world. This can cause a number of
metabolic changes if it occurs early enough in life. The client will present with a higher cortisolto-insulin ratio with lower IGF-1 levels. This will cause her to have lower muscle gain and linear
growth, impaired lipolysis, and fat oxidation. The client will then present with an overweight and
shorter frame due to the slower metabolism (Sawaya, et. al., 2004).
If malnutrition begins after growth has completed, significant effects continue to appear.
Mazess, Barden, & Ohlrich conducted a study to determine the effects of anorexia on the
skeleton and body composition in eleven young women. These women weighed an average of 15
kilograms less than their peers of a normal weight, and their fat mass was four times lower. Their
skeletons contained around 25% less mineral, with their spinal bone mineral density nearly
nonexistent (Mazess, Barden, & Ohlrich, 1990). These women would appear excessively thin,
and have very brittle bones. With prolonged malnutrition, the clients risk for osteoporosis and
bone fractures increases greatly.
To begin the process of improving HOs nutritional intake, a SMART goal should be set.
The goal will help the client in having something to aspire to and it will also help her understand
exactly what she will need to do in order to accomplish what is required of her. A SMART goal
that would be effective in improving HOs diet is: The client will consume adequate nourishment
in the form of three meals each day, all of which contain an item from each of the five food
groups, and she will limit her intake of empty calorie food to one serving per day within the next

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two weeks. With this goal, the client will have time to adjust to a new dietary schedule, and she
will be closer to meeting the USDA guidelines for nutritional requirements.
HO and I will sit down and create a dietary plan together, following the USDA MyPlate
template. This template displays a dinner plate with adequate portions of all of the main food
groups, with fruits, vegetables, grains, and protein each receiving one quarter of the space on the
plate, and dairy accompanying it, and lists the daily requirements for each of the five food groups
(Dudek, 2014). She will create a food log for the first week of the process to determine whether
she has begun to advance toward meeting the goal, or reconfiguring the SMART goal to better
suit her.
Evaluation
After one week of the intervention, HO and I met once again to determine her progress.
She did not succeed in eating a single meal within the week that encompassed each of the five
food groups. When she and I discussed what happened, she stated that her busy schedule got in
the way of her eating enough food in that week, and she was willing to attempt to eat better in
the next week. This first week in which the client took a record of all of the food that she had
consumed may not have been a success, but this week did help her. She moved forward in the
Transtheoretical Model to the next stage of change. HO is now in the preparation stage, and
attempting to begin the action stage. With preparation, the client is intending to make the change
within the next month, after a recent failure in the past year, and the action stage is where the
client actually begins to modify her behavior and better herself (Transtheoretical, 2015).
HO and I discussed the SMART goal and our feelings on any changes that may be made,
and she stated that she wanted the chance to attempt to complete it again. A change that I
suggested was to create a reward system for eating a full meal. For each meal she ingested each

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of the five food groups, she would receive a star, and then she could reward herself with a new
game if she were to fill the chart with stars. She will progress with the initial SMART goal and
record a second food log with the star chart, and we will meet again to determine her progress, or
if another change will need to be made by then.

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Appendix A
Real Age Results

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Appendix B
Daily Food Log

Food Log
Wednesday
Thursday

Friday
Saturday
Sunday
Monday
Tuesday

Bagel with cream cheese

Tacos
Bagel with cream cheese
Grilled Chicken sandwich with lettuce
and tomato and fries
Grilled chicken breast
Bagel with cream cheese
Chili Dog
Raisin Bran with 2% milk
Fettucini alfredo
Bagel with cream cheese
Chicken breast with fries
Bagel with cream cheese
Chili
Bagel with cream cheese
Chili
Reduced sodium Ramen Noodles

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Appendix C
Client Feedback

Dear HO,
After reviewing the food log that you have provided, I would like to discuss with you the
positive and negative results that have been determined. First, I would like to congratulate you
on eating a meal for breakfast every single day of the week. Beginning the day with a highcarbohydrate meal helps to jumpstart the bodys metabolism for the day, ultimately giving you
more energy to last the day. Another positive item that I found was that you opted for grilled
protein options multiple times throughout the week. This is a great step towards eating a healthy
diet with low-calorie options.
There are some items that need some drastic improvement, however. First of all, fruits
and vegetables need to make a larger appearance in your diet. They both help to provide essential
vitamins and minerals to the body. The second item I would like to cover is red meat. This was
your main protein for meals in four out of seven days, and that is far too much red meat for one
week. This protein is filled with saturated fat, and must be limited in the diet to remain healthy
and keep your cholesterol levels within normal limits. If you improve on these factors, and
increase your calorie level for each day, you will be on your way to living a healthy life. I believe
it is important for us to meet one more time and determine your progress as of that point. You are
well on your way to reducing your risk factors and becoming a far healthier version of yourself.

Emily Mortensen

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References
Balch, P. (2003). Preface. In Prescription for dietary wellness (2nd ed., p. Xi). New York, New
York: Avery.
Bay, N., & Bay, B. (2010). Greek anatomist Herophilus: The father of anatomy. Anatomy & Cell
Biology, 43(4), 280-280.
Dudek, S. (2014). Guidelines for Healthy Eating. In Nutrition essentials for nursing practice (7th
ed., pp. 186-189). Philadelphia: Lippincott Williams & Wilkins.
King, N., Hopkins, M., Caudwell, P., Stubbs, R., & Blundell, J. (2009). Beneficial Effects Of
Exercise: Shifting The Focus From Body Weight To Other Markers Of Health. British
Journal of Sports Medicine, 43(12), 924-927.
Ladwig, G., & Ackley, B. (2014). Mosby's guide to nursing diagnosis (4th ed.). Maryland
Heights: Elsevier.
Mazess, R., Barden, H., & Ohlrich, E. (1990). Skeletal and body-composition effects of anorexia
nervosa. The American Journal of Clinical Nutrition, 52(3), 438-441.
Oz, M., & Arnold, J. (2015). Sharecare. Retrieved March 30, 2015, from
https://www.sharecare.com/
Sawaya, A., Martins, P., Grillo, L., & Florencio, T. (2004). Long-term Effects of Early
Malnutrition on Body Weight Regulation. Nutrition Reviews, 62(S2), S127-S133.
Transtheoretical Model: Stages of Change. (2015). Retrieved March 30, 2015, from
http://web.uri.edu/cprc/transtheoretical-model-stages-of-change/
Zimmerman, G., Olsen, C., & Bosworth, M. (2000). A Stages of Change Approach to Helping
Patients Change Behavior. American Family Physician, 61(5), 1409-1416.