Case Study

HPI: Mrs. Williams is a 55 y/o female with a PMH of Type 2 DM x 5 years and HTN x 20 years. She presents for her annual checkup and tells you that her sister (62 y/o) just had a “heart attack”. Mrs. Williams says, “I’ve finally realized it’s time I did something about getting in shape – before it’s too late.”

Social Hx: Manager of a travel agency, lives with her husband, never smoked, drank alcohol, or used drugs. Occasionally watches her 2 grandchildren in the evenings and/or weekends.

Vitals & Labs

• • Weight: 200 lbs (BMI 38)
  • BP: well-controlled w/ meds (128/80)
  • A1C: higher than target (not on insulin, but may be needed if not controlled)
  • TC: 240
  • HDL: 40

Goals: Weight Loss, Glucose Management, Improve Cholesterol (to avoid being placed on statins)

Diet Plan

Diet Hx – feels she doesn’t have time to cook due to long work hours, though she used to enjoy it when she was younger. Likes vegetables but rarely eats them b/c she lacks the time and motivation to prepare them, but would eat them if someone prepared them for her

Breakfast

• • Weekdays: cereal w/ milk and occasional donut & coffee outside her workplace 
  • Weekends: eggs, bacon, potatoes, and toast or waffles 

Recommendation(s)

Weekdays: depending on the cereal brand, would suggest substituting it with minimal sugar content and higher fiber and substituting milk for a fat-free option. 

Weekends: would suggest substituting the bacon and potatoes with options like oatmeal, boiled eggs, or an avocado toast to swap the unhealthy fats for healthier ones

Lunch

• • Getting food outside her workplace → McDonald’s, pizza, Halal cart

Recommendation(s)

If eating out, would suggest choosing healthier choices (e.g., salads, Chipotle, Cava). Would also strongly suggest meal prepping to incorporate home-cooked meals to have better control over what goes into her food.

Dinner

• • Usually chicken from a store with sides, or soup and bread; sometimes she makes baked ham with candied yams and green beans  

Recommendation(s)

I would strongly suggest adding more greens (of her choice) to be the bulk of the meal, as it’s not incorporated throughout her day

I would also include a variety of proteins if she gets sick of getting chicken and ham (e.g., tofu, salmon)

I recommend avoiding making dinner the heaviest meal of the da,y as she is tired when she gets home, and we don’t want her having a food coma that can lead to further weight gain

Snack

• • Cookies, Chocolate

Recommendation(s)

• • Substitute for dark chocolate, nuts, yogurt, granola, fruits, vegetables (e.g. carrots, celery, cucumbers) & hummus 

Exercise Plan

Exercise Hx: appears to be sedentary → can walk on ground level w/o difficulty and can walk up a flight of stairs. When she was younger, she enjoyed biking and dancing.

Recommendation(s)

I would recommend starting a walking goal of 30min/d and then gradually increasing the pace & duration, performing yoga/stretching exercises, biking (stationary or non-stationary) 15-30mins few times a week, and gradually increasing intensity & duration

For comfort and motivation, also recommend joining group/community dance classes, playing with her grandchildren, and/or going to the park

Overall, the recommendations made would support her goals for weight loss, glucose management, and improving cholesterol levels. Home cooking and meal prepping are strongly recommended to give her better control and a sense of what goes into her body. Incorporating activities and exercises that she used to enjoy can make exercise enjoyable for her. We can also involve her husband and grandchildren in cooking at home and in physical activities to make the whole process more enjoyable, fun, and create bonding moments.