NCMA 215 Course Task 17 - Lecture Module

Week 10
Andrea B. Autor BSN 2YC-2
Patient 1: Pam Age: 40 y/o/Single Ht: 5 ft 4 in. Wt: 80kg (lowest weight she had was
55kg about 3 years ago) BP: 160/90 claims to take some antihypertensive meds; none of
which she can remember. She has followed strict diets and has never exercised in her
previous weight-loss attempts. Her favorite foods include fried foods, fruits, sweet
delicacies and soda–which helps digest her food faster. Her hectic schedule often means
eating out or buying to go from a convenience store near where she lives.
Nutritional and behavioral counselling for Patient Pam.
Patient Name: Pam Age: 40 y/o
Topic: Obesity
Goal: To reduce weight

Objective: Ht: 5 ft. 4 in Wt: 80kg BMI: 30.27 Obese Class 1

Time: 1 hr
Methods: Psychodynamic and Interpersonal Counseling
Resources: Data based
Indicatiors: Lifestyle and age

Based on the given weight and height of patient Pam, she is in obese class 1 in the
classification of her body mass index (BMI). I see that in her busy schedule she will just
buy foods from a convenience store (where most of it were ready to eat meals) since she
has no time to cook her own meal. No wonder why patient Pam weighted 80kg since she
didn’t balance her diet and didn’t focus on the nutrients of what she eats.

Patients do not want their primary care clinicians to assume all of their problems (such
as a sore throat) are weight-related. In so, I will address patient Pam’s main health
concerns first. I’ll let her talk about other issues that may be affecting her physical or
emotional health, such as family or work issues. I will open the discussion about weight
in a respectful and nonjudgmental way. Patients may be more open if they feel
respected.

Before asking patient Pam if she wish to discuss her weight, I’ll mention the health risks
associated with overweight and obesity. I’ll ask her like this:

“Hi, Ms. Pam. How are you feeling about your weight at this time?”
Also, I’ll be alert and sensitive to cultural differences about patient Pam may have about
weight, favorite foods, social norms and practices, and related issues.
Next that I’ll do is to ask patient Pam about her eating and drinking patterns. I’ll ask her
like this:
 “I’d like to learn more about your eating habits. What kinds of foods and
beverages do you eat and drink on a typical day?”
 “What does ‘healthy eating’ mean to you?”
 “Do you eat only when you’re hungry, or do you eat for other reasons as well,
such as feeling stressed or bored?”
 “When is the amount of food and beverages you eat and drink likely to change
(for example, when you eat out or at work or family celebrations)?”
 “How do you think keeping a journal will help you track how much you eat, drink,
and exercise?”
Next, I want patient Pam to talk about her physical activity so I’ll ask her like this:
 “When would be the best time of day or evening for you to be active?”
 “What kinds of activities do you enjoy? Do you like walking? Seated aerobics?
Do you prefer activities you can do alone, with someone else, or in a group?”
 “How much time do you spend sitting each day? Would you like to try to work
some physical activity into your daily routine?”
After asking patient Pam some questions, I’ll begin to help her plan her diet. The
primary approach for achieving weight loss, in the vast majority of cases, is therapeutic
lifestyle change, which includes a reduction in energy intake and an increase in physical
activity.1,2,4 There is no evidence to suggest that specific components of the diet
(carbohydrate, fat, protein, vitamins, and micronutrients) influence the ways in which
food energy is absorbed or used up. Therefore, the main dietary method for reducing
weight is to reduce the total amount of calories consumed, and this is best achieved by a
reduction in the amount of fat from the diet and calories from soft drinks. A moderate
decrease in caloric balance (500–1000 kcal/day) will result in a slow but progressive
weight loss.
I should know that patient Pam is aware that there will be a big change in her lifestyle
enable for her to achieve her diet. Therefore, I’ll help her stick to set and stick with the
goal by asking her these sets of questions first:
 “What are some goals you could set regarding your weight?”
 “What kind of changes would you be willing to start with?”
 “What kind of help would you like to meet your goals?”

I’ll her patient Pam to set a SMART goals for losing weight, or goals that are specific,
measurable, achievable, realistic, and time-sensitive. For example, a goal of walking 30
minutes a day 3 days a week for 2 months, rather than a more general goal of becoming
more active. Another SMART goal would be to replace soda with water every day for the
next month, rather than a goal to give up all sugar.
Once your patient Pam determine her goals, she can begin to identify concrete actions or
changes she can make to meet her weight goal over 6 months. Having patients start with
just two or three actions or changes may make them seem less overwhelming and more
realistic.

Some patients may lose weight very slowly, which can discourage them. Point out any
health improvements, such as lower blood pressure and cholesterol levels. Improving
health numbers, along with praise, may help motivate patient Pam and boost her self-
esteem.