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Lifestyle Management of Adult Obesity


Table 3 below summarizes the results of the client's initial, 90-day, 180-day, and 1 year follow-up physical fitness tests. She lost 31 lbs (1.19 lbs / week) and achieved a BMI of 29.26. Her estimated exercise capacity increased 30.7% from 7.5 to 9.8 METs. Submaximal heart rate at 6.0 METs decreased by 19 bpm suggesting improved cardiovascular function. Although the weight loss may have improved mechanical and therefore physiological efficiency, the oxygen requirement of a standard workload is relatively constant. Thus a lower heart rate at 6.0 METs suggests a greater stroke volume to achieve a similar cardiac output. The 26 bpm decrease in resting heart rate also suggests a greater resting stroke volume and a more efficient pump.

Body fat percentage decreased from 41.2 to 30.7% suggesting a loss of 30 lbs of fat and 2 lbs of lean body mass. Flexibility increased by 3 inches as measured by the standard Sit and Reach Test. She also increased her strength as measured by the leg press, bench press, and seated press by 28%, 28%, and 20%, respectively.

The client's blood work completely normalized at six months (see Table 3) as did her resting blood pressure which averaged between 120-130/80-85 mm Hg prior to her regular exercise sessions. Her American Heart Association and Framingham 10-Year CHD risk was now < 1.0%. At six months, her physician decided to decrease the Pravachol® dosage to 10 mgs/day.

Table 3: Blood work (initially, after 180 days, and after 1 year)
Parameter Initial 180 Days 1 Year
Total cholesterol 242 mg/dl 177 mg/dl 175 mg/dl
Triglycerides 211 mg/dl 104 mg/dl 112 mg/dl
HDL-cholesterol 39 mg/dl 50 mg/dl 52 mg/dl
LDL-cholesterol 151 mg/dl 106 mg/dl 101 mg/dl
Fasting plasma glucose 211 mg/dl 104 mg/dl 102 mg/dl
Hemoglobin A1c 8.4% 5.9% not done

In our experience, most clients with similar presenting symptoms and diagnoses can normalize most of their risks for CVD through aggressive lifestyle changes. It would be of interest to repeat her sestamibi exercise test but her physician does not feel this is warranted since she is completely asymptomatic and reports markedly increased energy (one of her key goals). Her health also is much improved which was another of her key desired outcomes.

She still desires to lose another 24 lbs to achieve a 25 BMI. However, she has become comfortable with her body image "independent" of her bodyweight. In addition, studies show that, although she remains overweight, her risk for CAD is actually less now than a similar age woman with a BMI of < 25.0 who is inactive and unfit. [78] [79] At the 1 year follow-up, blood work remains normal. Fitness test results also are slightly improved over the 180 day follow-up test. Mrs. Jones continues to exercise regularly, wears the pedometer most days of the week, and eats a low fat diet. She recently had some moderate symptoms of fatigue and weakness which resulted in a diagnosis of a benign thyroid nodule. This has been successfully treated and she is now ready to gradually lose the additional desired weight.

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Last Update: March 6 2013