Case Study: A Pre-Diabetic Middle-aged Man

Case Study: A Pre-Diabetic Middle-aged Man


Around the world today, more than 2
billion people are overweight or obese. Our global obesity epidemic has been
described as the most significant preventable public health
crisis in recent history. This 48-year-old manager of a construction
firm found himself fighting an uphill battle against a disease that can effect
every organ system in the human body. Kevin’s wife had convinced him to
visit their local medical clinic, because she was concerned
about his weight, and the joint pain he complained
of every evening after work. At the clinic, Kevin was told that his
fasting blood sugar was elevated, and that he was prediabetic. His triglycerides, total cholesterol, and LDL cholesterol were also elevated and
his HDL cholesterol was low. Standing 5’7″ tall and weighing 180
pounds with predominant central obesity, Kevin’s physician calculated a BMI
of 28 kilograms per meter squared. Kevin was informed that he was overweight
and suffering from metabolic syndrome, a collection of biochemical and
physiological abnormalities associated with the development of cardiovascular
disease and type two diabetes. The physician on duty advised Kevin
to make some major lifestyle changes. By eating better, and
getting more exercise. Six months later, Kevin returned to
the clinic weighing nine pounds more than he had at the previous visit. When the new physician on duty asked if he had been able to make any of the lifestyle
changes suggested by her colleague. Kevin told a story she had heard
far too many times before. The first week after his
last doctor’s visit, Kevin had tried eliminating all
of his favorite foods and snacks. He skipped breakfast, drank a meal
replacement shake for lunch and ate a calorie reduced frozen
dinner in the evening. He had also tried to eliminate
the fat in his diet. The first week, Kevin lost four pounds but
as the weeks went on he found it impossible to stick to
this planed restrictive diet and he noticed that he was replacing
his favourite high fat foods like potato chips and
pizza with foods that were high in sugar. In the evening he would find
himself in front of the television, snacking on multiple
packages of Swedish fish. By the time he went to bed, he would
almost always feel he had over eaten. The soda machine at work became his
enemy as he tried unsuccessfully to walk by without buying the cold soda cans that
he ended up drinking usually three or four times a day. He and his wife both worked long hours so
one of them would usually stops for take outs on the way and
they would end up sharing a pizza and a two liter of Coke,
exhausted from their long days of work. Regular exercise was difficult for
Kevin because of his joint pain and he often felt that he just
didn’t have the energy to move. The physician took notes and
asked clarifying questions as Kevin spoke. Identifying major target areas for change. Including specific food and eating behaviors that were contributing
to Kevin’s uphill battle with his weight. She asses Kevin readiness to make dietary
changes and asked if the couple had access to simple cooking tools like a pot,
a knife and a cutting board. Then she spoke with Kevin and
his wife about the importance of avoiding highly processed foods in order to
achieve their health goals for Kevin. Together, they came up with a stepwise
action plan that would allow them to gradually reallocate a small amount
of time to the preparation of simple, home cooked meals. In this way they could once again be
in control of the fat, sugar, salt, and total calories they were consuming. Kevin and his wife enrolled in a free
online nutrition and cooking course and began tracking their food intake
using an online food blog. To help them control portion sizes, their physician advised them to buy a set
of affordable smaller dinner plates and glasses that they found at
a local hardware store. The couple kept their meals simple,
but made sure that each plate was composed of one-half plant-based
foods like fruits and vegetables. WIth the other half of the meal
made up of lean protein and whole grain carbohydrates. Over the next four weeks, they gradually began to feel
more comfortable in the kitchen. Kevin tried his hand at
making veggie omelets and a stir fry and
even a homemade tomato sauce. He started to feel pretty good about the
food that he was able to prepare at home. On Sundays when they had more time,
Kevin’s wife would cook a stew or a pot of vegetable soup and freeze
these meals in smaller containers for later on in the week. Following his action plan,
Kevin gradually replaced the sodas he once drank daily with
unsweetened sparkling water. Six months later, and
with regular follow up visits, Kevin’s weight had dropped to 165 pounds. And his joints were no longer hurting him,
allowing him to start walking regularly. His fasting blood sugar level and
his lipid profile had both improved. And he told his physician that he had
more energy and was actually enjoying his food more now because he no longer felt
guilty about his poor eating habits. He and
his wife found that they talked more now that they were spending a bit more
time in the kitchen together after work. They sat down for meals together and made a pact to stop snacking
in front of the TV. They even found their new eating habits to
be more economical because they shopped for groceries once or twice a week instead
of buying each meal separately, and usually buying more food than they needed. 18 months later, Kevin had managed
to keep the weight off and his fasting blood sugar
had returned to normal. Kevin told his physician that he felt
better at he age of 49 than he had at 39. Life as a healthy middle age
man was treating him well and he couldn’t imagine ever going back.

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