Case Study
Patient Background: Jose Garcia is a 68 yo male with a PMH of HTN, high cholesterol, arthritis and pre-diabetes diagnosis. He lives a relatively sedentary life due to retirement since 3 years from taxi driving. He is a current smoker and smokes about a half pack a day. He is currently on blood pressure medication.
Goals: Weight loss and Avoid Diabetes
Clinical Information:
BP 148/88 on his BP meds
Fasting glucose 120
Weight 250
Height 5 ft 6 in
Waist circumference 45 inches
Diet:
Breakfast- Jose usually gets a buttered roll from coffee shop and on weekends eats eggs or pancakes that his wife cooks
Suggestion: Instead try a whole grain butter roll from the shop to increase fiber intake and limit the additives sodium, sugars, and saturated fats. Also, his wife should use vegetable oil rather than butter, shortening, lard or coconut oil which contain high concentrations of saturated fats. Make sure to avoid coffee and start small by drinking less and less every day. For a healthy adult, 400 mg per day is a safe amount. Including vegetables in the eggs like spinach, kale, bell peppers and creating an omelette can incorporate more vegetables in Jose’s diet
Lunch– He usually has a sandwich or goes to a Dominican restaurant to eat steak and fried plantains
Suggestion: For sandwiches, Jose can eat healthier ingredients like whole grain bread, dark-green, red and orange vegetables, reduced-fat cheese and cook the meat in vegetable oil. Sandwiches usually contain 19% of saturated fat intake of Americans so it is important to use more nutritional options when building the sandwich. Having a side of salad and iced tea with no sugar can also be added to the meal. Jose would also have to be mindful of the ingredients in the salad dressing which can turn a healthy salad into a non-healthy option. Jose should go to the Dominican restaurant once every two weeks, and try to slow down eating the fried food and too much red meat.
Dinner– Jose eats home cooked meat or fish with plantains or rice and beans.
Suggestion: The meals should be cooked and fried in vegetable oil. Using an oven or air fryer can also reduce the saturated fats from oils in general. A healthier rice option can be whole grain. Lessening the amount of food Jose eats gradually can help with weight loss. Adding some dairy and vegetables can help Jose meet his daily requirements.
Dessert– He likes to eat pastries and flan (custard). He also eats chicharrones (fried pork skin) as a snack
Suggestion: For now, lessen the amount of desserts. Eat fewer chicharrones and limit to once a day and a small amount. It will be hard to make adjustments in the beginning so eating desserts and snacks in moderation would be the best thing, especially if Jose is eating healthier for the main three courses of meals for the day.
Exercise– Jose does not do much exercise and is able to walk up the stairs but experiences tachypnea after the exercise. He enjoyed biking and playing handball as a child.
Suggestion: Handball is a good exercise that will not cause tachypnea like walking or running does. It involves through a handball back and forth with someone and it would be a good start. Jose can play handball with someone 2-3 times a week. He can also take a 5 minute walk every morning, then extend it to 10 minutes and so on. Having a walking partner will help motivate him to walk. He can move on to more vigorous exercise after getting use to being active with gradual increase in intensity.
