Bruno Mars is 19 y.o. male college basketball player at Stanford University. He is a sophomore and has chosen to study p

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Bruno Mars is 19 y.o. male college basketball player at
Stanford University. He is a sophomore and has chosen to study
pre-med. Bruno is a very good student, with a 4.0 GPA, and is
described by his teammates as somewhat of an introvert. His
athletic trainer has referred him to you, the sports nutritionist,
secondary to a recent stress fracture in his shin. He has
also been sick three times with reoccurring colds since New Year’s
break.
During the initial interview, when you ask Bruno about
his eating, he denies any difficulty, stating he eats,
“super-clean.” Bruno is tall, 6’ 4”, has broad shoulders, and
reports weighing 200#. You notice his collarbones are
prominent, his cheeks look hollow and, upon probing, he admits to
having lost “a few pounds” recently. When further questioned, he
reports becoming a vegetarian while at home over the summer after
his freshman year. His parents felt he had gained too much
weight during his first year in college, so as a family they
started eating “cleaner,” eating primarily grains and
vegetables.
A 24-hr recall suggests Bruno eats only 2240 kcals each
day, although accuracy is difficult to determine because he avoids
the topic and is hesitant to recall his food. He indicates he eats
specific foods at specific times, and variety is limited, eating
the same foods each day because these foods “sit well” in his
stomach.
In addition to spending most of his day attending class
and studying, Bruno attends basketball practice and conditioning
practice. Basketball practice is 2.5 hours daily, six days
per week. Practice consists of stretching for 20 minutes, drills
for 60 min, walking through plays for 15 min, and scrimmaging for
the rest of practice. He also has conditioning with his team
3 days per week for 60 min. You estimate he expends ~950
kcals daily during basketball practice and 325 kcals during
conditioning. When questioned about the calorie discrepancy
between the number of kcals he consumes and expends through
exercise, he remarks that his sport requires quickness and power,
and that all his teammates eat and exercise this way. He adds
he used to have plenty of energy for practice and conditioning, and
now feels so tired in the evenings that it is difficult to stay up
to study. Bruno further explains that he is not really losing
weight but losing some “fat” on his “flabby
stomach.”
During your assessment, you determine that Bruno is 6’4”
tall, as he reported but weighs only 184#, a discrepancy from the
screening form he originally filled out. When asked about the
discrepancy, Bruno reports that he does not think he is thin.
Over New Year’s break, her parents complimented him on how much
better he looks and rewarded him with a new car. You measure
his body composition and estimate he has 7% body fat, resulting in
171.1# lean body mass.
In the beginning of the school year, Bruno performed
well at practice and games, and used his improving performance to
rationalize his “leaner” body, “clean” diet and long training
sessions. But his frequent colds have resulted in poorer
performance during practice, little gains in strength, and a recent
inability to finish some practices. He thinks if he just works out
more, he will improve. Now with a stress fracture, he is not
allowed to exercise and finds this very
frustrating.
During your interview, you notice Bruno shows very
little emotion, with minimal expressions and maybe even a little
sadness. Yet, at the same time, he seems anxious and restless as he
talks to you. During your conversation, you also find out
that over the summer he had relationship problems and broke up with
his girlfriend of 3 years.
Daily food and activity record:
Conditioning: 1 hour
Breakfast: ½ cup cooked oatmeal, 1 T slivered almonds, 1
tsp brown sugar, 3 egg whites, 1 tsp olive oil, ½ cup spinach, 16
ounces black coffee
Snack: Apple and water
Lunch: 2 oz egg salad, 2 slices sourdough bread, ¼ cup
lettuce, 1 cup dried fruit, 1 cup baby carrots, 16 ounces
coffee.
Basketball practice: 2 ½ hours: Nature Valley granola
bar, 16 oz water
Dinner: 2 cups cooked brown rice, 2 cups streamed
vegetables, 2 T shredded fat free cheese, 16 oz water
Snack: Banana, 2 T peanut butter, 1 cup fat free
milk
Review the above case presented on Bruno, and then
answer the following questions. Your paper should be type-written
(12-pt font) and double-spaced.
1. Conduct a nutrition assessment. Include
the following: (10 pts)
What is Bruno’s appropriate weight using
Hamwi?
What percent of his appropriate weight is he
currently?
What is his BMI and weight
category?
Using Mifflin-St Jeor, estimate Bruno’s resting energy
expenditure (REE). Add 75% to REE to estimate how many kcals
Bruno needs daily.
Compare that to how many calories he is
consuming.
2. Calculate Bruno’s energy availability. Is
this sufficient? [(kcals consumed - kcals expended through
exercise)/lean body mass in kg = energy availability in kcals/kg].
(5 pts)
3. Consider his eating patterns. How might
his eating contribute to his current situation? (7
pts)
4. How do you feel his sport, school and home
environments have helped him legitimize his attitudes and behaviors
toward food? If he has misconceptions, what are they? (7
pts)
5. What other reasons might Bruno have for
exercising so much and why might he be anxious now that he is not
allowed to exercise? (Hint: think about his emotional state and
personality). (7 pts)
7. How would you best describe Bruno’s disordered
eating, if you were to make a diagnosis? Consider the DSM-V
disorders, but do not restrict yourself to these categories.
Justify your decision, giving as many criteria, indicators and
reasons as possible. (10 pts)
8. There may be other information you want to
obtain from Bruno, his family, team mates and physician. If
so, what would it be? Support your rationale: why might the
information be useful? (4 pts)