Question

DX is a 39-year-old man who is seeking nutritional advice for weight loss and dyslipidemia.

Medical Diagnosis by MD:  Dyslipidemia, obesity

Initial Assessment of DX:

B/P: 118/75

Height: 6’0”

Weight: 238.8 lbs

Body fat: 24.1%

BMI: 32.4

History:  

DX is the owner/manager of a construction company and is somewhat active at his job. However, he reports that he mainly oversees jobs rather than doing the manual labor so estimates his activity level as between lightly and moderately active. He wants to lose weight and reports successfully losing about 20 lbs 6 years ago after working with a nutritionist. He has re-gained the weight but is confident that he can lose it again with some guidance. His health is good overall. However, he reports that he has struggled with very high triglycerides since he was in his early twenties. About 10 years ago he had his thyroid removed due to thyroid cancer. He manages this with Synthroid and feels well.

Medication and Supplements:

Synthroid- 200 mcg daily

Dietary Intake (recall data for a “typical” day):

Breakfast

no breakfast- only coffee with cream and sugar; occasionally eats pancakes on the week-ends

Lunch

usually buys lunch such as a grinder, chips, and diet coke or 3-4 slices pizza and diet coke (drinks 1 diet coke daily)

Dinner

most often chicken or pork and a large salad and bread or take-out

DX identifies after dinner snacking as a significant problem, with his food of choice being candy. He loves gummy bears.

He reports drinking “lots” of water; estimates about 64 oz daily

Alcohol intake described as a “few drinks” on the week-end

Questions:

1. What is the chief complaint to be addressed with DX?
2. What is your assessment of his diet? Please include both positive observations as well as areas that could be revised. It is not necessary to provide a full dietary plan here. You will be asked to provide recommendations in Part 2 of this case.
3. What further information would you elicit? Keep in mind the four types of nutritional assessment- clinical, anthropometric, dietary, and biochemical. Explain your rationale for the assessments you suggest.

Answer 1

Answer: DX is having serious problem of obesity and he needs to loose weight and he has struggled with very high triglycerides since he was in his early twenties.

Answer: The diet he is taking is not at all going to help him to loose weight, because his diet consists of all junk foods and caffeinated breverage. He needs to cut off sugar intake as well as fatty products. he needs to include more and more healthy foods and green vegetables such as broccoli, pumpkin. Chicken is ok for the dinner as white meat contains lots of protein.

Answer: Anthropometric measurements are used to assess the size, shape and composition of the human body, Where as dietary measurment includes accurately assessing dietary intake is an important element of metabolic research. He needs dietary measurement.