Case

Study
Patient TC
Kayleigh Caito
April 13, 2016

Introduction...3

Causes of Obesity....3

Health Effects and Risk Factors.....4

Food Environment and Obesity....4

Treatment of Obesity...5

The Case Study.5

Methods...6
Results..6
Discussion..9
References...12

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Introduction

Obesity is an epidemic in the United States and across the world. About 36%

of the United States is classified as obese (1). Obesity can be classified as a body
mass index (BMI) of over 30 (2). BMI is a ratio of weight and height to give health
professionals an idea of a persons weight status (2). This ratio is weight in kg over
height in meters squared (3). Most people believe that BMI is a direct measurement
of body fat, which is untrue (2). For example, some athletes have a BMI in the
overweight range, but do not have excess body fat (2). This is because an athletes
body mass index may be more muscle than fat (2). However, BMI is typically a good
assessment of whether a normal adult is within a healthy range of weight based on
their height (2). BMI is used to determine if a person is at risk for certain diseases
or health problems (2).

Causes of Obesity

Obesity can be caused by a multitude of factors. Some causes of obesity are

modifiable, and some are non-modifiable. Modifiable factors can be changed or

stopped to help prevent obesity. Some modifiable causes include behavior, social
events, smoking, lack of sleep, physical inactivity, and unhealthy eating habits (3).
Poor eating behaviors can include an intake of excess amounts of food due to lack of
motivation, lack of resources, or lack of knowledge (2). Non-modifiable risk factors
cannot be changed, but can still cause obesity. Some non-modifiable factors
contributing to obesity include genetics, hormones, pregnancy, and age (3).

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Health Effects and Risk Factors

There are many complications associated with obesity. The two main
diseases associated with obesity are cardiovascular disease and type 2 diabetes (1).
Some other major health risks include metabolic syndrome, stroke, cancer,
gallstones, sleep apnea, and fatty liver disease (3). These can be potentially life-
threatening health risks. Some other risk factors include altered lab values such as,
high triglycerides, high LDL, low HDL, high cholesterol, and high blood pressure (3).
These factors are typically associated with a person who has obesity, and put a
person at higher risk for the diseases previously mentioned.

Food Environment and Obesity

Food intake has a major impact on a persons weight and overall health. It is

important to be consuming high-quality, whole foods to promote healthy living (4).

There are certain foods that are believed to be associated with obesity. These
include foods high in sugar, trans fats, and processed foods (4). There have been
studies that show a direct correlation with sugar sweetened beverages and obesity
(4). It has also been shown that portion sizes have increased over the years (4). As
these portion sizes are increasing, people are eating more at each sitting, which
promotes weight gain (4). These patterns should be stopped in order to slow the
obesity epidemic.

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Treatment of Obesity
Obesity can be treated and prevented. Since obesity is mainly caused by an
overconsumption of calories, the main treatment is to reduce calorie intake (3). In
order to lose weight, one must consume fewer calories than they are expending (3).
It is important to improve quality of food eaten when trying to combat obesity (3).
Eating more whole grains, fruits, vegetables, and healthy fats will improve overall
health (3). It is also important to eat lean proteins, such as poultry, fish, low-fat
dairy, and plant proteins (3). Cutting out added sugars and limiting sodium intake
will help with obesity prevention (3).
Physical activity is also important as a treatment of obesity (3). The
American Heart Association and the American College of Cardiology recommend
that healthy adults engage in 30 minutes of activity per day for five times a week (5).
Exercise has been shown to improve insulin sensitivity and metabolism to reduce
risk of cardiovascular diseases (5). Exercise has also been shown to help with
improving mood, boosting energy, and help with sleep (6).

The Case Study
A case study was performed on an aging white male with obesity. The case
study was performed to determine if evidence is consistent with the research on the
risks and health problems related to obesity. If the patient in the case study suffers
from severe obesity, then they will have complications related to obesity, which
include several of the following; heart problems, cancer, stroke, altered lab values,
joint pain, gallstones, and/or sleep apnea.

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Methods

Patient TC was interviewed and asked several questions about current

dietary intakes. The patient was asked for data on current medications, family
history of diseases, other diseases or illnesses, current lab values, current problems
associated with obesity, and activity level. The data collected during the interview
was analyzed to determine current health problems and risks associated with the
patients obesity. Questions regarding current height, weight status, and former
weight status were used to calculate BMI, ideal body weight, and weight change.
Current energy needs, such as kilocalorie, protein, carbohydrate, fat, and fluid needs
were also calculated using weight and height. Patient TC was asked to keep a 3-day
food record. The record was then checked using the 5-Step Multi-pass Method to
ensure accuracy. The record was then analyzed using SuperTracker to give the
macronutrient and micronutrient breakdowns of the foods.

Results
During the interview, Patient TC listed current medications. He is taking
Atenolol for hypertension, Pantoprazole for heartburn, and Xalatan for glaucoma
(7). TC noted other health problems including benign arrhythmia, metabolic
syndrome, melanoma, and glaucoma. TCs family history for diseases include high
blood pressure, diabetes, heart and prostate cancer, melanoma, and glaucoma. TC
stated that he has current heath problems associated with obesity including joint
pain in the knees and lower back. He states that he is currently trying to exercise
more frequently, and is participating in purposeful activity three times per week for

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30-50 minutes each session. TC reports that he switches between cardio and
weight training each day.
TC reported his most current lab values from Jan 13, 2016. He reports a BP
of 128/82, which is borderline high (8). TC has a lipid breakdown of HDL at 39, LDL
at 150, VLDL at 66, and triglycerides at 329. TCs HDL is slightly low (poor), and his
LDL, VLDL, and triglycerides are all high (8).
Based on the values for patient TCs height and weight, calculations were
performed to determine BMI, IBW, %IBW, UBW, %UBW, and % weight change.
Table 1 shows the weight assessment of Patient TC. TC has a current BMI of
47kg/m2, which is classified as morbidly obese (obese class III). He has an ideal
body weight of 166 pounds, plus or minus 10%. TC shows a %IBW of 202% of his
ideal body weight. His %UBW is 112%, a 10% increase in the past two years, which
is not significant.
Table 1
Height
CBW

1.8m
152 kg

BMI

47kg/m2

IBW

166# +/-10%

%IBW

202%

UBW

300#

%UBW

112%

% Wt. change

10% in 2 yrs

Table 2 shows the estimated needs of macronutrient distributions for Patient
TC. The patient is slightly under consuming his kilocalories at 82% of his needs to

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sustain his current body weight. TC is also under consuming protein at 66% of
needs, and fluid at 85% of needs. TC is only consuming 25% of his kilocalories from
carbohydrates, which is low based on the recommended range of 45-65% of
kilocalories from carbohydrates (9). Patient TC is also over consuming fat,
consuming 37% of kilocalories from fat. This is over the recommended range of 20-
35% of kilocalories from fat (9). From the SuperTracker analysis, TC is consuming
12% of fat as saturated fat, which is above the recommended saturated fat intake
(10). His sugar intake is within range (10). From the SuperTracker analysis, the
patient shows excess intake of sodium, consuming 3,530mg per day, a 153%
overconsumption (10). SuperTraker also showed an under consumption of fiber at
12g/d, which is 48% of needs (10). The nutrients that were very low were calcium,
potassium, magnesium, and iron (10). Vitamins that were insufficient were vitamin
D, vitamin E, and vitamin K (10).
Table 2

Needs

Actual Intakes

% of Needs

Interpretation

Energy Needs

3300 kcal/d

2705 kcal/d

82%

Slightly low

Protein Needs

182 g/d

121 g/d

66%

Low

Fluid Needs

4560 cc/d

3870 cc/d

85%

Low

Carb Range

45-65% kcal

166 g/d

25% of kcal

Below range

Fat Range

20-35% kcal

111 g/d

37% of kcal

Above range

Sugar Range

<330 g/d

32 g/d

Within Range

Sodium

<2300 mg/d

3530 mg/d

153%

High

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Discussion

There are many complications associated with obesity. Some include

cardiovascular disease, diabetes, stroke, cancer, pain, high blood pressure,

hypertension, and others (3). Based on the study done on patient TC, he has several
of these complications, including heart problems, high blood pressure, altered lab
values, metabolic syndrome, a history of cancer, joint pain, sleep apnea, and a
history of gall stones. These complications are most likely due to patient TCs
obesity.
Patient TC is classified as morbidly obese with a BMI of 47. Based on his
three-day record, TC is not getting adequate nutrients. He did not consume any
fruits, whole grains, and very little dairy. He did not have any homemade meals, and
ate out two times a day. His poor intake is potentially a main contributing factor for
his obesity and other health-related complications.
Patient is not meeting proper macronutrient level distributions. TC is under
consuming carbohydrates and protein, which can be contributing to excess fat
storage and muscle wasting. TC was also consuming mostly refined grains as
opposed to whole grains, which increases sodium levels, and can increase
inflammation. The patient should be substituting whole grains for refined grains to
help with fiber intake and overall health. TC should also be consuming more
protein. Fortunately, most of his protein was from more lean sources, like chicken.
By adding in more protein, the patient can have greater satiety and decrease any
muscle wasting.

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The majority of TCs calorie intake is from fats, especially saturated fats.
These poor intakes can be contributing factors to patients metabolic syndrome,
obesity, and heart problems. Patient should focus on consuming more healthy fats
and oils, such as unsaturated fats. This could help decrease the risk of heart
problems and help decrease inflammation.
TC was also under consuming certain micronutrients such as calcium,
potassium, magnesium, and iron vitamin D, vitamin E, and vitamin K. These are
important for overall health, especially in the aging process. TC was not eating
much variety in the diet, which can be a cause of these inadequate nutrient levels.
By eating more variety and more fruits, vegetables, and dairy, TC can get many of
these nutrients from his diet.
TC has a family history of heart problems, and currently has benign
arrhythmia. TC is taking Atenolol for his heart. Patient is consuming a high amount
of sodium each day (153% overconsumption), which could be contributing to his
heart problems. His heart problems are evidenced by his high lab values of blood
pressure, high LDL, high VLDL, high triglycerides, and low HDL. If patient does not
lower sodium intake, he could be at risk for worsening hypertension, heart attack,
or heart disease.
TCs obesity can be contributed to several factors including high calorie
intake, poor variety in the diet, high fat and sodium intake, low activity level, and
age. He is showing several health problems related to obesity, which are putting
him at risk for more complications, and even death. Patient should make changes to

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the diet and increase activity level to treat his obesity. By doing this, he will have
overall better health and an increased life expectancy.

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References
1. DeVallance E, Fournier SB, Donley DA, Bonner DE, Lee K, Frisbee JC, Chantler
PD. Is obesity predictive of cardiovascular dysfunction independent of
cardiovascular risk factors?: Int J Obesity. 2015 Feb; 39(2):24-253.

2. Eatright.org [Internet]. Chicago (IL): Academy of Nutrition and Dietetics;
Defining Overweight and Obese; 2016 Feb 8 [updated 2016 Jan; cited 2016
April 12].

3. Mayo Clinic [Internet]. Scottsdale (AZ): Mayo Foundation for Medical

Education and Research; Obesity; 2015 Jun 10 [cited 2016 April 12].
4. Mattes R, Foster GD. Research issues: the food environment and obesity: Am J
Clin Nutr. 2014 Dec; 100(6):1663-1665.
5. Wei X, Liu X, Rosenzweig A. What do we know about the cardiac benefits of
exercise?: Trends Cardiovas Med. 2015 Aug; 25(6):529-536.
6. Mayo Clinic [Internet]. Scottsdale (AZ): Mayo Foundation for Medical
Education and Research; Fitness; 2014 Feb 5 [cited 2016 April 12].

7. RxList [Internet]. [Place unknown]: RxList; 2016 [cited 2016 April 12].
8. Hamady C. Lab Values: FN4110: Nutrition Care Process. Powerpoint
presented at; 2016; Bowling Green State University.

9. Hamady C. Dietary Standards: FN4110: Nutrition Care Process. Powerpoint
presented at; 2016; Bowling Green State University.

10. SuperTracker [Internet]. Alexandria (VA): SuperTracker; 2016 [cited 2016
April 12].