Celine Veneria F.

dela Cruz
I- PHN
CASE STUDIES
1. A 45-year-old man comes in for his annual physical.
Height 5’10”, weight 210 lb, nonsmoker, no history of CAD, DM, or dyslipidemia.
On questioning, he is unconcerned about his weight, which he attributes to “too much food
and too little exercise.” His wife, however, has been nagging him to lose weight.
On physical exam, he is moderately obese, BP 140/99, pulse 78 and regular, waist
circumference 42 inches; no other abnormalities detected.
Clinical assessment:
1. What further evaluation would you perform?

Lipid profile blood chemistry test, BMI, IBW, TCR, Thyroid testing, ECG

2. How would you address his obesity?

Orientation of the patient regarding the risk factors obesity can bring must be first done.
Next, the patient should set his goal to live a healthy lifestyle with a stable mindset
with proper diet and physical activity. Planning of proper caloric diet and arrangement
of physical activities should be made. Monitoring and social support is advised from
the wife, friends and family of the patient to boost his motivation for weight loss toward
a healthy lifestyle.
2. A 32-year-old woman comes to your office requesting “diet pills” because “I’m too
fat.”
Height 5’5”, weight 149 lb.
Difficulty losing weight after her second pregnancy 18 months ago; about 8 pounds heavier
than her prepregnancy weight.
Always overweight—lost and regained 10 to 15 lb numerous times.
Used to go to a gym to exercise 2 or 3 days a week—now no time because of her young
children.
On physical exam, no abnormalities detected; waist circumference 30 inches, BP 118/72,
pulse 84 and regular, lipids and glucose within normal limits.
Clinical assessment:
1. What is her BMI?

BMI= weight in kilogram/ height in meter squared

BMI= 67.59 kg/ 1.65m2
BMI= 24.85 kg/m2
 2. Would you prescribe weight loss medications?

No, weight loss medications are done only after attempting the use of non drug
interventions for the first six months of weight management. In addition, the patient’s
waist circumference is within normal limits of less than 31 inches and the patient’s BMI
is within the normal range of 18.5 kg/m2 – 25 kg/m2.

3. What would you advise her regarding weight management?

I would advise my patient to try the combined therapy which results as the most
successful for weight loss and maintenance that includes a combined intervention of
a calorie-deficit diet, increased physical activity, and behavioral treatment. I would tell
her that the best way to lose weight in a long-term span has no shortcut like that of
diet pills which may result to short term weight loss due to lack of discipline in the diet
and absence of exercise. Discipline of oneself is the ultimate key to attain a long-term
regimen of weight loss. Diet pills may be used only when needed or after the first six
months of non drug interventions.
3. Based on YOUR most recent or estimated height and weight, compute for the following:
1. Your Body Mass Index

BMI= weight in kilogram/ height in meter squared

BMI= 48 kg/ 1.55 m2
BMI= 20 kg/m2

2. Your Ideal Body Weight

IBW= 47.7 kg

3. Your total caloric requirement per day

TCR= 1680 kcal/kg

4. Based on a diet divided into 3 meals in a day, come up with a one-day sample menu.
Refer to the Carbohydrate and Fat exchange List provided.
Breakfast Food Item Calories
Fruit

Milk

Fish or Substitute
Rice or Substitute

Sugar

TOTAL: 680 calories

Lunch: Food Item Calories
Vegetable

Fish or Substitute

Rice or Substitute

Fruit
Sugar

TOTAL 570 Calories

Dinner: Food Item Calories

Vegetable
Fish or Substitute

Rice or Substitute

Fruit
Sugar

TOTAL: 430 Calories