Question

The patient just graduated college with a degree in Mechanical Engineering and is working full-time for the Department of Transportation. He is 25 years old, diabetic and lactose intolerant. His blood pressure is 134/91, he weighs 225lb, he is 5ft 9in tall and his waist circumference is 44in. He had a cholecystectomy when he was 24 years old and has experienced an increased number of bowel movements and some gastrointestinal discomfort since he had the surgery. He also expressed that he does not eat dairy products in general but he usually eats two containers of yogurt every day (see food label below) as a snack because its easy and convenient for him. When asked about his daily physical activity, he admits to only walking around his neighborhood maybe once a month. He was asked to keep a record of his diet for a week and these are some of the results: 3425 kcal/day (total intake), 1321 kcal from lipids, 250 kcal from protein and 1854 kcal from carbohydrates.

1. Is he overweight or obese? Why?
2. What method would you choose to estimate BFP if it’s necessary? Why?
3. Is he eating more or less than he should? Why?
4. How many grams of protein should he ingest on a daily basis to maintain (in a healthy way) his current weight?
5. What are some of the problems with his current diet? (be specific and backup your answer with data) What dietary changes should he make to help him lose weight?
6. What percentage of his daily value of protein (based on his EER) does he get from eating yogurt?
7. Based on his medical history, why do you think he eats yogurt every day?
8. What do you think is the cause of his increased frequency of bowel movements and gastrointestinal discomfort he has experienced since his surgery?

Answer 1

1. The patient is obese, as can be asserted by his BMI. BMI or body mass index is a measure of body fat based on the person's height and weight that applies to adults (men and women). The formula for calculating BMI is weight in kg divided by height in meters squared. In this case the BMI would be,

225 lb/5 ft 9 in

= 33.2

BMI of 30 or greater falls in the category of Obesity.

2. The best method to estimate BFP (body fat percentage) in this case would be to measure the Basal Metabolic Rate (BMR). This method is an estimate of the amount of energy used while at rest. Since, the patient's daily calorie intake is mentioned, using the BFP calculator it may be ascertained as to what his daily calorie intake should be.

BMR = 10W + 6.25H -5A +5

Where W is weight in kg, H is height in cm, A is age

= 10×102 + 6.25×179 + 5×25 +5

= 1020 + 1118 + 125 +5

= 2268 calories/ day

3. For a person with a BMI of 33, and a BMR of 2268, and based on his activity level which is mild to sedentary, his calorie intake is more than what is recommended.

4. As pointed out in numerous researches, increasing protein intake can improve metabolism, counter certain food cravings and also decreases appetite as proteins help to maintain the feeling of fullness. Research also suggests that consuming 25% of daily calories from proteins, cuts the desire for late night snacking.

The patients daily protein requirement would be

.8-1.0g of protein/kg of body weight

The patient weighs 225 lb

(225)/(2.2g/kg) = 102 kg

102 kg(.8g/kg)= 81.6 g

102 kg (1.0g/kg)= 102 g

That is, 81-102 g of protein/day

The ideal changes that can be made to diet to reduce weight would be to consume a low calorie diet, and also adopt a calorie deficit diet, increase physical activity, consume a protein dense diet. Cutting down on carbohydrates is an effective way to lose weight as it reduces appetite thus ensuring you consume lesser calories. Studies have also shown that consuming a lie carbohydrate diet is more effective in reducing weight than a calorie restricted diet. Daily exercise has a variety of health benefits other that weight loss which includes lower risk of disease, increased energy etc.

5. 100g of yogurt provides about 60calories and 10g of protein. This would suggest that the patient is receiving 13% of his daily protein requirement, supposing that he consumes about a 100g of yogurt a day.

6. Lactose in yogurt is better tolerated than lactose in milk by individuals who are lactose intolerant. Yogurt also causes fewer symptoms of digestive distress.

7. Removal of the gall bladder (cholecystectomy) makes it difficult for the body to digest fat which results is gastric discomfort and symptoms such as diarrhea and flatulence. This is a common side effect of cholecystectomy.