68-year-old male, retired. (All patient information has been fabricated)
Height: 66in Weight: 250lb Waist: 45in
PMH: HTN (on medication to control), considered prediabetic with FBS 120, high cholesterol, and arthritis in both knees.
Current Exercise: Little to none. Patient became tachypneic to 30RR after one flight of stairs. Enjoyed sports when he was younger.
Goals: Lose weight and avoid advancing diabetes.
Exercise
Since retiring three years ago, Mr. Garcia has found himself with much more time on his hands, though not spending any of it being active. Due to years as a cab driver, Jose has developed arthritis in both knees which can make any strenuous/rigorous activity more difficult. The best thing he can do to become more active is to simply take short walks daily. The CDC currently recommends 150 minutes per week (roughly 20 minutes per day) to improve health-aerobic activity. This moderate activity would give him a target heart rate of 91-127 which he can track once educated on calculating his pulse in our office. As he slowly begins to feel comfortable at these shorter increments, he can try to add activities to challenge himself more. Going to the park and playing a very low intensity game of handball can reignite his joy in playing to make it part of his daily routine instead of sitting at home.
Diet
With current measurements, Mr. Garcia has a BMI of roughly 45 which is well over the lower limits of obesity. Slow, small changes in his diet can create a daily caloric deficit to help him lose weight.
- Breakfast – Substituting the buttered roll with whole grain toast can drastically decrease the carbohydrates and fat while also adding a small amount of fiber
- Lunch – While the steak may help fulfill his daily protein requirements, I would suggest Mr. Garcia limit his intake of red meat to no more than twice/week per AHA guidelines. As an alternative, he can find leaner proteins such as chicken, turkey, or fish. Further, there should be an addition of colorful vegetables as sources of many nutrients he would not be getting with friend plantains.
- Dinner – While it is great that Mr. Garcia is able to enjoy home-cooked meals for dinner, the biggest suggestion is that he begin to limit his portion size. During any meal, you should only eat until you are satisfied as opposed to when you are stuffed and tire yourself out. Having his wife at home as a support system is an incredible advantage as she can also introduce healthier grains and proteins to his meals on a regular basis.
- Snacking – I believe it is very important to maintain a healthy relationship with your food and do not believe cutting out all snacks achieves anything other than making you want those items more. Mr. Garcia states that he does enjoy his pork rinds and I would not want to take that from him because it makes him happy. However, because these foods are high in both saturated fat, cholesterol, and sodium, my plan would be to set specific parameters to enjoy them such as only one day a week while sticking to one serving portion as directed on the product rather than an entire bag. At other times I would suggest snacking on a piece of fruit of a bowl of berries to help lower the fat intake.
Sources:
https://www.choosemyplate.gov/eathealthy/vegetables/vegetables-nutrients-health
