Which of the following might indicate the need for dietary changes in Tina's case?

The indication that changes to Tina's diet are necessary stems significantly from her history of Gastroesophageal Reflux Disease (GERD) and her dietary habits. GERD is often exacerbated by specific foods and eating behaviors, such as consuming large meals, lying down after eating, or eating trigger foods like spicy or fatty items. By assessing her history of this condition alongside her current dietary habits, healthcare providers can identify targeted adjustments that may alleviate symptoms and improve her overall gastrointestinal health.

This combination of factors highlights the importance of a personalized approach to nutrition, as dietary management plays a crucial role in managing GERD. While low energy levels and family history of digestive disorders are relevant, they do not provide the same specific insight into potential dietary improvements tailored for managing GERD. Age can also have implications for dietary needs, but by itself, it's insufficient to warrant changes without considering the context of medical history and eating patterns.