Case Study:

Amy Reyes, Is a 35 year old women grieving due to loss of wife to cancer. 

Few months ago:

• She complains of being “tired all the time. Based on conversation you suspect poor sleep as the central issue. 
• Lost 15 pounds, states she has trouble getting herself to eat.
• Unhappy with appearance, feels weak. 

Most recently:

• Patient is responding well with antidepresents
• she feels “out of shape”
• would like guidance on diet and exercise to get strength back.
• regained 5 lb but is still below her usual weight (current BMI is 18)
• BP 100/70

Health history: 

• no family history of heart disease
• father has type 2 diabetes

Goals:

• eat healthier and make sure son does as well
• get back in shape and feel stronger.

 

Potential areas for improvement:

• Based on patient’s current diet, she has low protein intake. Tell patient it would be beneficial to incorporate more protein into her current diet especially since her goals are to have more strength and to get back into shape. Carbohydrates are important for the patients energy level as well. Although the central issue causing the patient to be “tired all the time” was due to poor sleep, carbohydrate intake is also important for patient to have adequate energy. Patient may also be under consuming calories and nutrition as she is below her normal weight and not feeling strong.

Breakfast: 

Current: Cereal (that are not “super sweet”)  and milk with fruit on top. 

Recommend: 

• Since patient already eats cereal with fruit for breakfast we can adjust this to be more nutritious: 
• Nutritious Cereal ( high fiber, low sugar cereal brands:Kashi, Ezekiel 4:9 sprouted whole grain cereal,  Nature’s path organic smartbran etc.), with Greek yogurt/cottage cheese, nuts and fruits. Top with honey for extra sweetness. This should be enjoyable for her son as well. 
• If she would like another option, another easy breakfast that will be quick and easy to make for a new cook is scrambled eggs with some veggies and cheese and a side of toast.
• These options will give her some healthy fats as well as some extra protein in her breakfast.

Lunch:

Current: Salad from the local salad bar or sometimes slice of pizza.

Recommend:

• Salads can remain in the nutritional plan as long as they are including proteins and carbs and not just lettuce. 
• If the patient continues opting for the salad bar, her salads should include a protein source, such as chicken or fish, along with healthy fats like avocado. Adding a carbohydrate, such as quinoa or farro, would help create a more balanced meal. Since the patient is not underweight but actually needs to gain weight, she should aim to make her salads more calorie-dense.
•  Another option at most salad bars is wraps, which she could fill with the same ingredients, providing a convenient alternative to salads if she does not want to have a salad.
• Pizza can be okay once in a while, as it’s important not to completely eliminate foods especially if she and her son likes it. I would recommend her not eating it everyday though as it will not align with her goals.
•  When having pizza the patient can opt for healthier pizza options, such as those with a whole wheat crust, topped with vegetables, lean proteins like grilled chicken, and a lighter amount of cheese.

Dinner:

Current: Left overs from mom once a week. Take out or prepared food from deli/grocer. Son will get a fruit for dessert.

• – Since Amy’s mom provides a meal once a week, that covers one out of seven dinners.
• Amy should try to make some home cooked meals even if she feels a bit out of practice. To simplify cooking, she can base meals on one protein, one carb, and one vegetable. For dessert she can continue her fruit with her son. To save on time she can also meal prep on days where she has more time, left overs can also be packed for her and her sons lunch.
• She could choose a few lean proteins they enjoy, like salmon, chicken, or tofu, and pair them with vegetables and carbs such as rice, pasta, or baked potatoes. Mixing and matching these will create a variety of easy, balanced meals.
• I would like to challenge Amy to try and cook a Filipino cuisine once a week. This can be through following a online recipe or family recipe. She could turn meal prep into a bonding activity with her son, helping to build healthy habits for him as well.
• While take out is not ideal, as Amy is a single mom it is understandable if she is very busy and may need to rely on it once in a while. If Amy is is buying a meal from deli or grocer, make sure it includes carbohydrates, proteins, and vegetable bases as a guideline to choose a balanced meal. We can set a goal to limit this to once a week.
• Continuing fruit is a good idea for dessert. It is important to remember fruit is healthy but in high amounts there is still a good amount of sugar. Since Amy has family history if diabetes she should be cautious to not over do sugar. 1 cup of fruit is a good guideline for fruit for her and her son after dinner..

Snack:

• As the patient is going to do more exercising to increase her strength, it is important to either make sure her portions are large enough for meals so she is getting the fuel she needs. This is especially important because the patient is currently still below her normal weight and we would not want this to drop further.
• On the other hand she can also supplement with healthy snacks such as nuts, fruits, granola/protein bar, or yogurt to ensure she is properly fueled with food throughout her day. Example. Bananas are a great energy boosting fruit as well as many nuts.

 

Exercise plan:

Current: Walks approximately 9 blocks daily. Works desk job. Has ran and played soccer (high school) in the past but no longer does so. Note: son is currently in swimming class and patient is a single mom and may have limited time. Patients goal is to get back in to shape and feel stronger

• Patient lives a relatively sedentary lifestyle. I recommend patient find a active hobby she enjoys. CDC recommends 150 min/wk moderate intensity or 75 min/wk vigorous intensity aerobic active and 2 times a week muscle strengthening.

Exercise plan options:

• Option 1: join a adult soccer league if this fits her lifestyle. Understandably, she is a single mom and this may be too time consuming for her. Once to twice a week for over an hour for high intensity aerobic activity.
•  Option 2: she can be going back to running which she enjoyed before her significan other got sick. She can set a goal of a 30 min moderate intensity jog once a day 5 times a week. This will help her reach her aerobic exercise guidelines. She should supplement with some muscle training at home twice a week. This can include at home work outs, lifting some weights, push ups, sit ups, yoga.
• Option 3: Patient can also enroll in mother son swimming courses. This can be a way patient can get some exercise while spending quality time with her son. This can be once or twice a week for at least 1 hour. Swimming is a sport which involves aerobic activity and strengthening of muscles.
• Any of the above options will help her reach CDC guidlines as well as build strength which is her personal goal. Patient can also mix and match options and things she likes.
• 9 blocks of walking daily is not enough. Educate patient on how she has family history of type 2 diabetes and should therefoe is at risk as well. According to the CDC, with just 150 min of moderate intensity physical activity you can decrease risk. Furthermore, increased physical activity can reduce risk of serious outcomes from infectious disease and also lower risk for developing several common cancers.

 

https://www.niddk.nih.gov/health-information/diabetes/overview/preventing-type-2-diabetes/game-plan

 

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3355124/

 

https://www.cdc.gov/physical-activity-basics/benefits/?CDC_AAref_Val=https://www.cdc.gov/physicalactivity/basics/pa-health/