Question

41. Jane is a 42-year old school teacher who has been referred to you by her physician for weight loss. Jane is 5’5” and weighs 170 lbs. The following lab values were obtained from her physician:

Blood pressure: 145/93

HDL-C: 42mg/dl

LDL-C: 140mg/dl

Fasting blood glucose: 99 mg/dl

Fasting triglycerides: 178 mg/dl

Jane does not smoke, does not have any obesity-related disease, and is not taking any medications. Her waist circumference is 34 inches. Her mother had a heart attack when she was 63 and her grandfather had a stroke at the age of 70. Based on NIH’/NHLBI’s Obesity Guidelines what is your assessment of her absolute risk status? Explain how you came to this assessment and show any calculations that were necessary. (10 pts)

42. (1) What is the NIH/NHLBI’s recommendation for setting her initial goal weight and time frame for this weight loss, (2) is this a reasonable rate of loss for Jane (3) what are the rationales for this/your recommendation? (10 pts)

Answer 1

Q41

Answer: For the risk assessment include

1. BMI calculation

BMI is calculated by the height and weight of the patient. weight in kg is divided by height in meter square ( if pounds and inches are used then weight in pound multiply by 703 and divide by height in inch square)

weight = 170 lbs

height = 5 feet 5 inches = 65 inches

Use the formula, (weight in lbs x 703) / height if inches square

= (170 x703) / (65)²

= (119510)/4225

= 28.3

2. Abdominal circumference

the waist circumference of the patient is 34 if more than 35 have high risk for developing diseases.

The BMI is 28.3 which is overweight, and waist circumferences less than 35, the patient has an increased risk for developing the cardiac disease, hypertension, and diabetes type 2.

3. other risk factor assessment includes

HDL = less than 35 mg/dl

For the patient. the HDL level is 40 mg/dl

BP = more than 140/90 mm Hg

For the patient, the blood pressure is 145/93 mmHg

LDL = more than 130 mg/dl

For the patient, the LDL level is 140 mg/dl

This shows that the patient is at high risk of developing cardiovascular disease and hypertension.

Q42.

Answer: The initial goal for the weight loss is 10 percent of the baseline weight of the patient at the rate of 1-2 pounds a week to be reduced.

Yes, it is applicable to the patient. The recommendation for weight loss

- dietary therapy: intake of low caloric diet, avoid of fast food or high fat contain food, adequate water intake,

- increase physical activities: 30-40 minutes of active physical activities for 3-4 times in a week.

- behavioral therapy:: This helps to motivate the change in behavior and lifestyle of the patient. It increases believe, thrust towards the health worker and prevent stress.