Case Studies

Case Study #1: School Vending Machines

You are a Registered Dietitian hired by the public school board to make recommendations about types of beverages to be sold in vending machines in high schools. Types of beverages that have been available in vending machines in the past include caffeinated and non-caffeinated regular sodas, Gatorade sports drink, and Starbucks Frappucino.

The decision-making process has become somewhat difficult for the school board because the beverage companies have provided a significant amount of funding for the schools. In fact, last year, the companies donated football uniforms and equipment for every player at every high school in the district (70 players at $650 each at all 15 schools). They also donated computer equipment to the libraries of each school. Athletic directors, coaches, and some teachers are extremely concerned about losing this funding. Others feel that optimal nutrition and hydration should be the priority.

• Each vending machine can hold 6 beverages. What beverages do you feel should be included for the high school students?
• Would you put any restrictions on times or places in which drinks can be sold?
• Do you think your changes will result in decreased profit from vending machine sales?
• What suggestions do you have regarding the potential loss of funding from the beverage companies?

Case Study #2: “Bulking Up”

You are consulting with a 15 year-old sophomore high school football player named Kyle who is 6’3” and weighs 211 pounds. Kyle’s father brought him to see you because Kyle had not been gaining weight at the rate they expected despite starting a rigorous weight training program and following a nutrition regimen recommended by their neighbor who is a former NFL player. Kyle’s father explains that in order to be considered for a college scholarship, he feels his son needs to weigh at least 275 pounds by his senior year.

Currently, Kyle’s daily diet includes 6 eggs and a protein shake for breakfast, two protein bars throughout the day (he misses his lunch period due to extra weight lifting), 16 ounces of meat at dinner, and then a fast food value meal (usually Big Mac, Fries, Orange Soda) at 11pm since eating a lot right before bed is supposed to help with weight gain. Additionally, Kyle is taking creatine at a level of 25 grams/day to help “put on the weight as fast as possible”.

Regarding workouts, Kyle states that he feels “sore all the time”. His strength has not decreased during the last 2 months despite training in the weight room 5-6 sessions/week. Kyle drinks 2-3 Rock Star energy drinks before conditioning; without these he says he doesn’t have nearly enough energy to make it through the whole session.

Kyle and his dad express confusion that despite following the high protein diet and working hard in the weight room, Kyle isn’t gaining weight (in fact, last week he lost 2 pounds). He is cramping up more than usually during conditioning runs. They hope that you can make further diet recommendations and also suggest a different or better brand of creatine and any additional supplements necessary for Kyle to reach his goals.

• What is your assessment of Kyle’s current nutrition and training regimen?
• Assess Kyle’s weight goal and how you might modify it:
• What specific nutritional strategies and modifications would you recommend?
• What supplements would you recommend to Kyle?

Case Study #3: Weight Gained During Injury

Allie is an All-American female collegiate gymnast is returning from ACL (knee) surgery that occurred 6 months ago. She has been medically cleared to do basic gymnastics skills and cardiovascular work in the pool and on the stationary bike. Allie is 5’2” and has always competed at 112 pounds. She has never had to “try” very hard to maintain this weight. Currently Allie weighs 131 pounds. She does not feel comfortable at this weight and she and her coach agree that she needs to lose 15 pounds by the start of the season, which is 6 weeks away.

Allie’s coach prescribes a diet that limits carbs to 50 grams/day. She is instructed to eat “absolutely no sugar”. He also requires her to do 60 minutes of extra cardio work each morning. He will not allow Allie to try any of her gymnastics skills until she has lost 5 pounds. He said that is a way to “reward and motivate her”.

She adheres to the diet during the day, eating primarily chicken breast, salad, and diet soda, but feels lethargic and very hungry. She stopped eating apples and berries (her favorite foods) since they are “so high in sugar”. She craves sweet foods all the time, so she eats lots of sugar-free candy. Late at night she wakes up “starving” and says she “stuffs myself with ice cream, cereal, and everything else in sight”. Allie wants this to remain a secret from her coach who doesn’t understand why she hasn’t lost any weight yet.

• What nutritional recommendations would you provide for this athlete?
• Do you feel that Allie’s current diet may be impairing her body’s ability to heal?
• What is the minimum level of carbohydrate you feel an athlete of this size, doing this type of workouts, needs?
• How would you justify your changes to the coach?
• Would you keep Allie’s information confidential as she requested?

Case Study #4: Master’s Marathoner who is Tired and Cramping

Ed is a 52 year-old man training for his 15th marathon. His general health is excellent and his goal is to run 2 marathons every year until he is 60. He runs 6 days/week with a group of friends and has successfully improved his running time each year. Lately, however, Ed has been experiencing two problems, which is why he seeks the advice of a Registered Dietitian (you). First, he has not been able to complete his long training runs due to just being more worn out than normal. At his recent medical check-up, Ed’s doctor determined that he had slightly reduced hemolglobin and a ferritin of 18ng/mL. The doctor gave Ed an iron supplement which he took for a week but discontinued because it caused constipation.

Secondly, Ed has a history of developing muscle cramps (especially in his hamstrings and calves) on runs that last longer than 16 miles. Recently, his running partner even took him to the hospital where he was treated with IV fluids. Ed always runs with a camelback (water pouch that sits in a small backpack) filled with water. He drinks about 20 ounces of water per hour that he runs (more if it is extremely hot), so he feels there’s no way he could be dehydrated. He also started taking potassium supplements because he has heard they will prevent leg cramping.

Ed and his family emphasize healthy eating in their home. They are vegetarians (no meat or eggs but they do eat animal dairy products) and strictly avoid processed foods and adding sugar and salt to foods they make at home.

• What recommendations would you make to Ed regarding his iron levels? What diet changes should he make? Should he try taking the iron supplement again?
• Are there any other nutritional factors you would assess considering that Ed is a vegetarian?
• What do you suspect is causing Ed’s muscle cramping? What changes would you recommend in Ed’s daily diet? How about in his fluid regimen during runs?