Chapter 2: Prepare client diet plan

Client diet plans are central to the practice of Nutrition and Dietetics, requiring professionals to tailor nutritional interventions based on individual needs and health goals. In Kenya, dietitians working in hospitals, community health programs, and private practice must carefully develop dietary goals that reflect clients’ cultural preferences, medical conditions, and lifestyle factors. This chapter explores the systematic process of creating effective diet plans, emphasizing the development of dietary goals and the critical aspects of quality and quantity control to ensure client safety and nutritional adequacy.

2.1 Development of client's dietary goal

A dietary goal states what the client's diet is meant to achieve and by when. The dietitian writes it after the client has been assessed, and it directs every later step: the diet plan, the menu, the shopping and the follow-up visits. A good goal is specific, measurable, realistic for the client's situation, relevant to the health problem and limited to a period of time. A goal such as "eat better" cannot be checked, so it is not used.

Example: a client with raised blood pressure is given the goal "within six weeks, cook all home meals without table salt and flavour them with onion, garlic, lemon juice and herbs on at least six days a week." The goal names the action, the amount and the period, so the dietitian can ask about it at the next visit and see whether it was met.

2.1.1 Factors to consider when planning meals

A diet that is correct on paper still fails if the client cannot afford it, cannot prepare it or does not accept it. Before the goal is written, the dietitian therefore weighs three groups of factors together: those that belong to the client's body, those that belong to the client's means and surroundings, and those that belong to the client's family and community.

2.1.1.1 Biological determinants

Biological determinants are the features of the client's body and health that decide what the client needs and what the client is able to eat.

• Age and life stage: the need for energy and nutrients changes from infancy to old age, so a goal written for a young adult does not fit a growing child or an elderly client.
• Sex, body size and activity: a tall, muscular client who does heavy work needs more energy than a small client who sits for most of the day, and the dietitian uses the client's measured weight and height.
• Health condition and treatment: diabetes, high blood pressure, kidney disease, HIV infection and cancer each change what the diet must supply or limit, and some medicines alter appetite, taste or the way nutrients are absorbed.
• Allergies and intolerances: a food that causes a reaction is removed and its nutrients are replaced from a safe source. A client allergic to fish, for example, gets omega-3 fats and protein from other foods, and a client who reacts to wheat has ugali and rice in place of chapati and bread.
• Appetite, chewing and swallowing: poor teeth, mouth sores or difficulty in swallowing change the texture of food that the client can manage, and a poor appetite calls for small frequent meals that are rich in nutrients.

Example: a client with type 2 diabetes who is also allergic to fish needs the carbohydrate in each meal controlled and needs a protein food other than fish, so eggs, beans or lean meat are written into the plan.

2.1.1.2 Economic and physical determinants

Economic determinants decide what food the client can obtain, and physical determinants decide what the client can reach, store and cook.

• Household income and food prices: where money is short or irregular, the plan relies on affordable foods that carry the required nutrients, for example beans, eggs, small fish, cabbage, kale and seasonal fruit served with the family staple.
• Availability and season: a food that is plentiful and cheap in one season may be scarce in another, and a plan that lists substitutes stays workable all year.
• Distance to the market: a client who shops once a week needs foods that keep well without refrigeration, such as dry beans, cereals and dried fish.
• Fuel, equipment and storage: a home with one charcoal stove and no refrigerator cannot follow a plan that needs several dishes cooked fresh each day.
• Time and strength to prepare food: a client who returns from work late, or an elderly client who cannot lift heavy pots, needs meals that take little time and effort.
• Water and sanitation: a home without safe water cannot safely prepare uncooked foods or feeds for infants, and this limits what the dietitian can recommend.

Example: a casual builder who works long hours has a household of five and cooks on one stove. A plan that suits him cooks a large pot of lentils once, reheats it on following days and serves it with ugali and a vegetable, instead of asking for three different dishes each evening.

2.1.1.3 Social determinants

Social determinants are the customs, beliefs and relationships that shape how and what a client eats.

• Culture and tradition: each community has staple foods and ways of cooking them, and a plan built on foods the client already knows is accepted more readily than one that replaces them.
• Religion: some clients avoid certain foods or fast on set days, and the plan fits meal times and portions to the fast. A Muslim client who fasts in Ramadan eats before dawn and after sunset, so the plan places the main nutrients in those two meals and adds fluids.
• Food beliefs and taboos: a client may avoid a food because of a belief about its effect on health, and the dietitian listens, gently corrects beliefs that cause harm and respects those that do no harm.
• Family eating patterns: where one pot is shared by the household and the head is served first, the plan must be something the whole family can eat, and a client who is served last may need help to receive an adequate portion.
• Education and food knowledge: a client with little schooling needs short spoken or picture advice, while a client who reads food labels can be given more detail.
• Work and social life: meals eaten at work, at weddings or at funerals are partly outside the client's control, so the goal includes advice for those occasions.
• Social support: a client who has a helpful family or a community health promoter follows the plan more steadily than one who feels alone.

2.1.2 Quality and quantity control in meal planning

Quality control and quantity control make sure that the meals served match the plan. Quality control looks at the foods, the way they are handled and the way they are cooked. Quantity control looks at the amounts served. Both are checked on paper while the plan is made, again when the meals are produced, and again when the client's progress is reviewed.

Quality control

Three things are checked when the quality of a plan is judged.

• Nutrient-rich food choices: the plan favours foods that give many nutrients for the energy they supply, such as legumes, eggs, fish, vegetables and whole grains, instead of sweet and fried snacks that give little besides energy.
• Safe and fresh ingredients: ingredients are fresh, undamaged and stored correctly, and food that is ready to serve is held hot, at 63 °C or above, until it reaches the client.
• Appeal of the meal: how a meal tastes, feels and looks decides whether the client finishes it, and food that is left on the plate gives the client no nutrition.

Example: for a client who is regaining weight after a long illness and needs extra protein, a lunch of omena stew with kale and ugali is of better quality than plain ugali with tea, even if the two cost about the same.

Quantity control

Quantity control means serving the amount that the plan states, no more and no less.

• Standard portions: each food has a fixed portion in grams or in a household measure, such as a level cup of cooked rice or a serving spoon of stew, so that the client receives the planned amount on every occasion.
• Measuring tools: kitchen scales, standard cups, spoons and serving ladles are used in place of guessing, and food models or pictures help clients to judge portions at home.
• Matching portions to the need: a small portion of starch food suits a client controlling blood glucose, and a larger portion suits a client who has lost weight.
• Records of what is served: the amount prepared and the amount returned uneaten are written down, because food left on plates shows that the portion or the dish does not suit the client.

Consistency in meal planning

Meals of steady composition from day to day make progress easier to read. A client on a controlled-salt plan whose meals vary widely in salt cannot show whether the diet or the change of meals lowered the blood pressure. Standard recipes and fixed portions keep the composition steady.

Monitoring and adjusting meal plans

The dietitian reviews the client's weight, blood test results, appetite and food records at agreed intervals. If a client's blood glucose log shows high readings after the evening meal, for example, the portion of starch at that meal is reduced or the timing is changed, and the change is recorded and checked at the next review.

Chapter Summary

This chapter focused on the preparation of client diet plans by first exploring how to develop dietary goals that align with individual needs. It emphasized the importance of considering various factors such as biological, economic, physical, and social determinants when planning meals to ensure relevance and effectiveness. Quality and quantity control were highlighted as essential for meeting nutritional requirements while managing portion sizes. The principles of diet planning were discussed in detail, including adequacy, balance, calorie control, density, moderation, and variety, which together guide the creation of well-rounded diets. Several diet planning tools were introduced, such as food composition tables, food exchange lists, food guide pyramids, and reference standards, which assist in accurate meal formulation. Finally, the chapter outlined the systematic process for developing a client’s diet plan, integrating all these elements to tailor nutrition interventions that support health and wellbeing.