Question

You work at a Hospital in the Weight Management Department. A new patient has entered your program to lose weight and manage their diagnosis of metabolic syndrome. Below are the patient characteristics. (10 points)

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Dx: Obesity, Hypertension, hypertriglyceridemia

Age: 35 years old        Gender: Male Race: African American               BMI: 42 kg/m²       

SBP: 147 mmHg      DBP: 86 mmHg      TG: 245 mg/dl

Meds: Enalapril .1 mg/kg/day (2x per day); Niaspan 1500 mg per day, Qsymia 7.5/46 mg

Dr. Goal: Reduce body weight to help with Blood pressure and triglycerides through exercise and healthy eating

Patient Goal: Not be “Fat” and “Out of Shape”

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Part 1: Based on the information provided, what would your exercise plan look like for this patient? Is there any contraindications to your regimen based on the clinical profile? Explain. What is the outlook for exercise alone to provide positive clinical outcomes over a 3 month (12 weeks) period? That is, how much could the exercise program lower blood pressure levels, triglycerides and body weight? What type of nutrition strategy might you implement for this patient? Explain and provide an example in detail.

Part 2: The patient asks you how their medications work. Explain this and state specifically how these particular medication work. Finally, the patient asks you whether it will be possible for them to lose 50 pounds in 3 months and whether he can eventually stop his medications. How would you approach these questions and answer accordingly

Answer 1

35 year old African American man has entered with plan of reducing his weight to hospital. He has been diagnosed to have obesity, hypertension, and hypertriglyceridemia.

His Body mass index 42. He falls under category of morbid obesity under class II category

His blood pressure is 147 / 86 mm of Hg

His triglycerides is 245mg/dl

Part 1

His body mass index and his triglycerides are high. So he can be advised to follow mild to moderate exercise program to reduce his weight and triglycerides. Initially, the exercise started for about 30 minutes per day and gradually increased to its duration and intensity of exercise. He can be educated regarding types of exercise such as walking, cycling. Exercise such as cycling can increase weight loss than exercise like walking

He has been diagnosed as hypertension for which he has been consuming tablet enalapril for controlling his blood pressure. Only the severe uncontrolled hypertension is contraindication for exercise. Because exercise can increase blood pressure and causes hemorrhagic stroke. But he has mild hypertension and can be advised to continue exercise along with anti hypertension

Only by doing exercise, it is very difficult to reduce weight. It has been suggested that diet control along with exercise, helps to reduce weight. He can reduce weight that is one to two pounds per week, helps to achieve life time weight maintenance. In a three month, only 12 to 14 pounds weight can be reduced. He can reduce her calories intake 500 to 1000 calories, helps to reduce his weight one to two pounds per week. Hard Exercise only for about 30 minutes five time a week, helps to reduce weight of about 8 pound s in 3 months. Every two pound of weight loss helps to lower one point of blood pressure. For example if he walks for 3 miles helps him to lower 300 calories

Diet therapy: he can be advised to consume low calorie and low fat that is 800 to 1200 calories per day. This helps to make the body suffer from insufficient calories and use calories from catalyzing fat which is stored as adipose tissue in order to meet demands of the body

He can be advised fruit and vegetables to avoid constipation and get nutrients. it has to served 9-12 serving per day

He can be educated to avoid monocarbohydrates. Because monocarbohydrates increase appetite and increase blood glucose.

He can be educated to consume fish that contain omega fatty acids; white part of egg without yellow part can provide nutrients.

He can be educated to restrict fat intake (2 to 3 serving per day). He can consume skimmed milk to bone strength

he can be educated green leafy vegetables that is source of iron content and cause less fatique to him.

advise him to avoid fried foods such as chips, nuts such as fruit bar, sweets such as sugar, honey.

Part 2:

He can be explained regarding Niaspan helps to reduce triglycerides in his body. Niaspan 1500mg per day inhibits the release of fatty acids from the adipose tissue and reduce lipoprotein synthesis thereby it helps to decrease the lipoprotein and triglyceride synthesis. Thereby it may increase removal of chylomicron triglyceride from the plasma

He can be explained about QSYMIA medication that it helps to reduce weight loss by reducing food intake and decrease appetite QSYMIA medication is a combination of phenataramine and topiramate. Phenataramine helps to decrease food consumption, decrease appetite by releasing catecholamine

He can be explained regarding enalapril medication that helps to reduce blood pressure as he has been suffering from hypertension. Enalapril medication: it is the drug of antihypertensive and has been given to reduce blood pressure by inhibiting angiotensin conversion from its active form and the preventing release of angiotensin II

Weight loss should be done gradually that is one to two pounds per week. If he continues perform exercise and diet therapy helps to reduce weight about 12 to 24 pounds in a 3 month. This helps him to follow the exercise and adhere to weight reducing regimen. If he performs exercise to reduce weight more than two pounds that leads to frustration and skip the weight reducing regimen. He eventually stops his weight reduce medication after consultation with physician and stabilization of his weight. It should be stopped after consulting with health care provider, because sudden stopping of Qsymia can cause seizures. Enalapril should be stopped after consulting with health care provider. Sudden stopping without consulting and checking blood pressure, can cause higher blood pressure