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Lifestyle Management of Adult Obesity

Management Plan


After thorough discussion of the benefits, risks, and purposes of the procedure with the patient, it was decided to do a cardiac catheterization. This procedure revealed a 50% non-calcified lesion in her proximal right coronary artery and a 30-40% lesion in her mid-LAD with some plaqueing throughout the coronary tree, but no other significant stenoses. Left ventricular pressures were at the upper limits of normal and her ejection fraction was calculated to be 67%.

After discussion with the patient and family, it was decided to treat her with a trial of aggressive medical and lifestyle therapy. Due to the literature supporting the role of statin (HMG Co-A Reductase Inhibitors) therapy in stabilizing vulnerable plaques and reducing the risk of first heart attacks, she was placed on 20 milligrams of Pravastatin (Pravachol®). [58] She also was prescribed a baby aspirin (81 mg/day) for anti-platelet therapy. [59]

It was decided to treat her metabolic disorders initially with lifestyle changes which are clearly supported by several national and association guidelines. [50] [51] [52] She was referred to a Registered Clinical Exercise Physiologist and a Registered Clinical Dietitian for consultations and guidance in implementing a sound weight loss plan.

A high fiber, low fat, and low calorie diet and a three month supervised exercise program were prescribed. Goals of 30-45 minutes of aerobic exercise, 4-5 days per week, stretching and weight training for 20-30 minutes, 2-3 days per week, and a daily caloric intake target of 1400 calories per day to produce a weight loss of 0.5 to 1.5 lbs per week were established.

A Stages of Change evaluation revealed she was ready to take action to improve her health through increasing physical activity, improving her diet, and losing bodyweight.


Pertinent information

Type 2 DM, dyslipidemia, hypertension, sedentary lifestyle, obesity, possible coronary artery disease.

Consider

Cardiovascular endurance and resistance training exercise programs; increased lifestyle physical activity; addition of monounsaturated fat and omega-3 fatty acids to diet.



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Last Update: March 6 2013