Conducting a Client Nutrition Assessment

Written by Astrid Naranjo (Clean Health Accredited Clinical Dietitian)

In many countries, including Australia, there is currently an expectation amongst clients for fitness/PT services to have some level of nutrition service/advice included, particularly with regards to weight management, performance and dietary supplementation.

Since this sounds simple to do, asking what your client eats in a day is enough, right?

Well, not really. As a coach, your role is to know your client holistically, and nutrition isn’t just as simple as it sounds. You need to look for a whole range of things and factors that may influence your clients adherence, compliance and sustainable results.

We will cover a comprehensive framework, yet simple, that you as a coach can use to assess your client’s nutrition, without going beyond your professional scope of practice.

Before getting into the nutrition assessment method, let’s define what a detailed nutrition assessment is in the first place. A detailed nutrition assessment can be considered that in-depth evaluation of objective and subjective data related to an individual’s food and nutrient intake, lifestyle, and medical history (1).

You want to collect as much information as you can about your client. The reason why you have the opportunity to coach anyone is that they think you’ll help them reach a goal they wouldn’t or couldn’t reach on their own. To meet their expectations, you need to understand who they are as a person. What are their goals? What are their past attempts? How did they go with past attempts? You’ll need to go deep and uncover anything and everything that might impact what you recommend they do to get to their goals (2).

Therefore, goal setting should be a crucial part of your job when working with a client. The process doesn’t need to be complicated, but it’s an important aspect to initially focus on, as the clients can tell you what they really want to achieve from working with you and how can you actually help them from the nutrition, exercise and lifestyle point of view.

You know that the goal setting with your client has been effective when they can actually visualise their goal in their mind and the steps for making that happen. For you as a coach, this ensures you will know with better clarity the best coaching steps to take with the client and what information you may need to supply them with.

One of the fundamental aspects of goal setting is creating/coming up with outcomes in conjunction with your client. By setting effective goals or outcomes, you will be able to:-provide clients with a ‘purpose’, and a ‘direction’;-show them what they want, and how to chase after it;-be able to objectively assess their progress;-be much more likely to achieve a result.

By considering our clients’ goals as outcomes, we must also understand that these same outcomes bring changes and consequences too. As a coach you should, therefore, use a number of follow up questions to help your client visualise themselves at their end goal and what they may feel like as a result. This will show readiness for change and further enhance their commitment to their goals.

Some useful questions to ask could be:

• Where are you now?
• Where would you like to be?
• How would you know when you were there?
• On a scale 0 to 10, how ready are you to make this change now?

When your client sets goals, they are typically long-term outcomes. It can be challenging to measure the small changes or progress towards these larger more significant goals, and many people can get side-tracked or lost by not understanding how to track this progress.

By setting ‘mini goals’ with clients, they can see how their daily performances and processes are helping them progress towards their primary goal. By breaking the goal down into daily performances or specific tasks that would need to be completed to achieve the primary goal, progress is much easier tracked and noticed.

You also want to set clear expectations. Coaching’s a two way street of expectation. The client has a problem they expect you as their coach to help them solve, and you have a solution that you expect them as the client to execute. Understanding the client’s goals sets their expectations of you. You need to make sure that in the initial assessment.T

he way you go about collecting information will have a massive impact on how your client perceives you as a coach. So after goals have been set, now you will need context and background from your client. Thus, here you can implement the simple nutrition assessment method “ABCDEF”(3-5)

1. Anthropometric assessment
2. Biochemical assessment
3. Clinical assessment
4. Dietary assessment
5. Exercise assessment
6. Fotos (Photos)

Anthropometric Assessment
First, performing an anthropometric assessment. These are the basic quantitative data you’d expect any nutrition coach to collect: height, weight, girth, and body composition. From this data, you can calculate things like BMI or assess  body fat percentage against the body fat scale we discussed in an earlier lesson.

Biochemical Assessment
Next, the biochemical assessment.  Laboratory tests based on blood and urine can be important indicators of nutritional status, but they are influenced by non-nutritional factors as well. Blood work can give you a deep and completely honest view of what’s going on with a client’s health. A client may say they eat a “well-balanced diet” while their blood says they’re deficient in key vitamins and minerals. Blood work is a powerful tool but it requires deeper knowledge and understanding lab work.

Clinical Assessment
If interpreting blood work isn’t in your skill set, then refer out to a qualified health professional or a accredited dietitian.Next, clinical assessment, where you ask and learn about your client’s overall health history. This way, you can integrate information obtained from a past medical history, family history and social history and how these could influence or have an impact on your programming or their ability to comply? All of these give you clues about the roadblocks that could get in the way. The more you know about these roadblocks, the better you can plan for and avoid them.

Dietary Assessment
The dietary assessment is a crucial aspect (of course), this allows to stablish a baseline as starting point but also gives you hints of where can changes be made.  It helps you understand whether your client has or can learn the discipline to start eating healthy or make some changes. A food diary can be a good start, where your client logs everything (meals, snacks, shakes, coffees, drinks, candies, even medication and water) they put in their mouth for three typical days (including a weekend) (4-6).

Now, a three-day food log is adequate to get a client started, but ideally, you would have a client track their consumption using an app on an ongoing basis and share that data with you. Although food tracking apps aren’t perfect and have limitations, this can be a great tool for your client not just to learn about their actual intake but also to start mastering their nutrition with more knowledge and empowerment. This will also further highlight their current nutritional habits and their general relationship with food (6).

Finally, as part of the dietary assessment, make sure you’re collecting information about your client’s preferences and tolerances. Nothing will get a client off track faster than giving them recommendations of foods they don’t like or that their gut doesn’t tolerate (4-6).

Exercise Assessment
Next, the exercise assessment. You need to understand how much your client moves, how much and how frequent they perform a sport or exercise, since these data will be an important input to your calculation of their daily caloric needs. Overestimation can be common when it comes to their level of physical activity (7), so make sure to ask more detailed questions or even to ask for proof. If your client says they walk 10,000 steps a day, ask them to share their fitness tracker app data. If they say they do heavy resistance training ask them details of their workouts or ask them to walk you through their last few sessions.

Fotos (Photos)
Finally, you need to get photos. Transformation photos are the one thing that links every aspect of this business together. Before and after photos can spark inspiration and generate new leads.Photographs are also extremely important (even more so for online work) for creating tailored plans.  How can you create a plan for someone yet not have a clue what they look like underneath their clothes?

Photos can give you an idea of key information that you simply may not be able to get from questions (i.e  potential genetics, postural analysis, body fat distribution, level of muscularity, muscular imbalances and likely hormonal imbalances).It is best to get high quality images, including full body shots. To get the maximum value out of your photos, you need to ensure you have a system in place to capture the best ones possible. The key is consistency. Consistent clothing, lighting, background, camera height and angle are absolutely crucial. Try to aim for a white/clear background.

Takeaway:
You want to collect as much information as you can about your client. The reason why you have the opportunity to coach anyone is that they think you’ll help them reach a goal they wouldn’t or couldn’t reach on their own. Use the ABCDEF nutrition assessment method to collect key info and to understand who they are as a person. You’ll need to go deep and uncover anything and everything that might impact what you recommend they do to get to their goals.

Want to learn our industry leading nutritional programming methods based on the latest science and our experience of coaching over 250,000 personal training clients and more than 20,000 fitness professionals from around the world since 2008? Click here to enrol into the Performance Nutrition Coach online courses!

References

1. Dietitians Association of Australia. (2012). DAA Best Practice Guidelines for the Treatment of Overweight and Obesity in Adults
2. National Health and Medical Research Council. (2013). Australian Dietary Guidelines.
3. Sports Dietitians Australia Fact Sheets
4. Whitney E, Rolfes SR, Crowe T, Cameron-Smith D, Walsh A Understanding Nutrition: Australia and New Zealand Ed, 2 nd Edition, 2014
5. Carson JAS, Burke FM, Hark L, Cardiovascular Nutrition: Disease Management and Prevention American Dietetic Association, 2004
6. Scott JG, Cohen D,DiCicco-Bloom B, Orzano AJ, Gregory P, Flocke SA, Maxwell L, Crabtree B. Speaking of weight: how patients and primary care clinicians initiate weight loss counseling. Prev Med. (2004); 38: 819 – 827.
7. Willbond SM, Laviolette MA, Duval K, Doucet E. Normal weight men and women overestimate exercise energy expenditure. J Sports Med Phys Fitness. 2010 Dec;50(4):377-84. PMID: 21178922.