Member Satisfaction
Diagnosis: Hypertension, obesity
Background:
At time of referral, this morbidly obese patient with poorly managed high blood pressure had made many failed attempts at quick weight loss, and felt discouraged about the prospect of having to be patient and lose weight through lifestyle changes. She was not taking Xenical as prescribed for weight loss as she had frequent bouts of diarrhea. She was eating foods, such as bacon and sausage, for breakfast that are high in fats. She seemed surprised that this medication required her to change her dietary habits. The patient was reluctant to exercise as she had numerous orthopedic problems, including osteoporosis of both knees and a recent torn rotator cuff injury. She had lost and re-gained over 30 lbs in 3 years, and stated she felt she was "ready to give up".
Interventions:
CM provided simple suggestions to help increase daily activity level, including taking short walks, parking further away in the parking lot, and using stairs instead of the elevator. CM encouraged the patient to look at forms of recreation that would be low impact to her knees and would be enjoyable, with an ultimate goal of developing a routine exercise regimen.
CM helped the patient understand how to eat regular meals to avoid evening hunger and helped the patient understand portion sizes. CM recommended keeping healthy snacks on hand, such as fruit and low-fat yogurt. CM helped the patient take a long view on weight loss and worked to identify emotional triggers that could sabotage the patient's diet. CM helped the patient look at low fat foods as interesting and tasty alternatives to her usual high fat diet.
Results:
The patient has begun to lose weight, and is now compliant with dietary guidelines.
She thanked CM for the information sent to her, and stated managing portions rather than denying herself favorite foods made sense, and that she is applying these principals with her current meal planning. She is also making sure she eats a breakfast and a snack near bedtime, as this has helped her curb her appetite and she has learned it is better for her metabolism and insulin use. She has reduced her fat intake, which has relieved her of the symptoms she was experiencing earlier when taking Xenical. She is walking each day now, and reports she has had an 18-lb weight loss. She now avoids sodium by not using salt and by reading labels for sodium content. Her last blood pressure reading was 122/70, which is significantly lower than her previous readings, which always had been in the 140's systolic in the past.
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