Posted: August 12th, 2024

Obesity Nutritional Disorder Case Study

Obesity Nutritional Disorder
Patient’s Chief Complaints
“I need to lose some weight and I can’t do it by myself. I’m always tired and out of breath and my back and knees are killing me. I’d like to have stomach staples, if possible.”
HPI
B.L. is a 57 yo Hispanic woman of Puerto Rican heritage who states that she maintained her ideal weight, which she believes is about 115 lbs, until she was divorced 15 years ago. “I was in the military years ago and I was very trim at that time.” She has been continually gaining weight, mostly through “comfort eating” after her divorce. She also admits to nibbling on snacks at work—mostly high-calorie foods like brownies and Twinkies. She has previously tried OTC diet pills, multiple fad diets (South Beach and Sugar Busters), meal replacement diets (Slim-Fast), “water pills,” and most recently a combination of herbal products (chitosan and Garcinia). “I lose a bunch of weight over one or two months and then I gain it all back plus some.” She is tearful as she talks about her weight struggles. “I realize that my weight is affecting my health and I want to finally get some help to lose some and then keep it off for good.”
PMH
• HTN
8 years
• Gallstones 5 years ago, treated with lithotripsy and ursodeoxycholic acid
• Hypothyroidism
5 years
• Bilateral osteoarthritis of knees and lower back
• Depression
4 years
PSH
• TAH 20 years ago
• Carpal tunnel release surgery in both wrists 3 years ago
FH
• Father died at age 65 from complications after a traumatic fall; had “heart trouble” and HTN
• Mother died at age 80 from hip fracture and pneumonia
• Her only sibling is a brother who died at age 67 from bladder cancer
• One son and one daughter, both thin, alive, and well
• She states that her “mother and grandmother were heavy, but not obese”
• No other family members have a significant medical history
SH
• The patient is a divorced woman who lives with her 30 yo daughter
• She has never smoked and denies IVDA
• She has been a data entry clerk for the past 11 years and has been limited to sedentary
work because of her weight
• She feels insecure at work, because she is “the only employee working there without a college degree and I always have to prove myself”
• Before her divorce, she enjoyed walking for exercise. Now she is limited by her knee and back pain, limited mobility, and breathlessness.
• Except for her daughter, she is socially isolated and rarely has friends or family over to her house
• She watches a lot of television and feeds the birds and squirrels for enjoyment
Diet
B.L. met with a nutritionist several years ago and learned about the benefits of a low-fat, lowcarbohydrate diet, but soon became bored and frustrated with her food plan and stopped dieting. In her current attempt to lose weight, she has cut down her number of meals to one daily each evening that includes larger portion sizes and usually a baked dessert. Upon further probing, she admits to some snacking throughout the evening.
Meds
• Levothyroxine 0.15 µg po QD
• Acetaminophen 500 mg po PRN
• HCTZ 12.5 mg po QD
• Benazepril 10 mg po QD
• Doxazosin 4 mg po Q HS
• Imipramine 100 mg po QD
Patient Case Question 1. Which three medications is the patient taking for hypertension?
PE and Lab Tests
Gen
The patient is a pleasant, but tearful, extremely overweight Hispanic female in NAD.
VS
See Patient Case Table 98.1
Patient Case Table 98.1 Vital Signs
BP 138/88 T 97.5°F Waist 48 in
P 85 and regular HT 5 ft-1 in Hips 39 in
RR 30 WT 290 lbs SaO2 96%
Skin
• Warm with normal distribution of body hair
• No rashes or moles noted
HEENT
• Funduscopic exam normal
• Ears, nose and throat all WNL
Cardiac
• RRR
• S1 and S2 normal with no m/r/g
Lungs
CTA & P bilaterally
Breasts
Exam deferred
Abd
• Severely obese with multiple striae
• NT/ND
• () BS
• No palpable masses or bruits
• () HSM
• Hysterectomy scar well healed
Genit/Rect
Exam deferred
Ext
• () for lower extremity varicosities
• Palpation of knees reveals limited ROM, bony crepitus, and patient discomfort bilaterally
• Pedal pulses 2 bilaterally
Neuro
• A & O
3
• CNs II–XII intact
• Sensory and motor levels intact
• DTRs 2
• () Babinski
Laboratory Blood Test Results
See Patient Case Table 98.2
Patient Case Table 98.2 Laboratory Blood Test Results
Na 140 meq/L Ins 190 µU/mL PLT 190,000/mm3
K 3.9 meq/L AST 14 IU/L Cholesterol 314 mg/dL
Cl 107 meq/L ALT 29 IU/L LDL 195 mg/dL
HCO3 29 meq/L Bilirubin, total 0.9 mg/dL HDL 14 mg/dL
BUN 15 mg/dL Hct 49% Triglycerides 219 mg/dL
Cr 0.8 mg/dL Hb 17.4 g/dL TSH 3.7 µU/mL
Glu, fasting 118 mg/dL WBC 6,700/mm3 Uric acid 1.7 mg/dL
Arterial Blood Gases
PaO2  90 mm Hg; PaCO2  33 mm Hg; pH  7.35
Spirometry Tests
• VC  4000 mL
• TLC  5000 mL
• ERV  1000 mL
Chest X-Ray
WNL
Patient Case Question 2. Identify ten risk factors for obesity in this case study.
Patient Case Question 3. Identify ten health consequences that may have developed
in this patient from obesity.
Patient Case Question 4. Does the patient have any signs of liver dysfunction?
Patient Case Question 5. Other than the patient’s complaint of “always being out of
breath,” does she have any signs of abnormal pulmonary function at this time?
Patient Case Question 6. Does the patient’s hypothyroid condition need a drug dosage
adjustment at this time?
Patient Case Question 7. Into which class of obesity can this patient be categorized:
I, II, or III?
Patient Case Question 8. What is the risk for this patient to develop disease if she
continues at this weight?
Patient Case Question 9. Calculate the body fat percentage in this patient.

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