Sheila, 32 years old, has been referred to a registered dietitian following her 6-week postpartum check-up following her third pregnancy, as she has concerns about her goals of weight loss and still being able to meet her daughter’s nutritional needs through breastfeeding. This pregnancy was complicated by gestational diabetes, as was her second pregnancy. She gained 37 lbs and states she understands the need to lose her pregnancy weight to reduce the risk of developing type 2 diabetes; she wasn't successful with losing the weight from her second pregnancy. Her daughter was 9 pounds 11 ounces at birth and has been gaining weight appropriately. Sheila breastfed her first two children until they were approximately 5 months old. Her current weight is 223 lbs and her height is 5'5". She reports she hasn't started exercising yet, but she was medically cleared to do so by her physician. Sheila's 24-hour recall shows an estimated calorie intake of 2700 kcal with limited fruits and vegetables, one cup of milk, and portions of high-fat and sugary foods. She has been maintaining her weight with her current calorie intake. 1. What is an estimated daily calorie intake that would allow Sheila to lose weight? (Explain/show how you came up with your number.
2. What daily calorie intake would be considered too low to support breast milk production? (Explain/show how you came up with your number.
3. a) Are there any vitamins and minerals Sheila might have inadequate intakes of based on her 24-hour recall? (Explain why the nutrients you listed are likely to be short in her diet.
b) How would you recommend she adjust her food intake to meet her needs for these nutrients? (Give specific examples of foods that will increase her intake of the nutrients you listed in the first part of the question.
4. What other recommendations do you have for Sheila to assist with her weight loss goals?
5. How will Sheila know whether her daughter is receiving adequate nutrition while she focuses on her goal of weight loss while breastfeeding?