Description
A.

Complete a weight loss exercise booklet for a 70year old obese client with diabetes

B. Respond to the discussion boards below. 2 paragraphs (100-200 Words each) each discussion board

1rst Discussion Diet/Nutrition/Obesity/Food insecurity

Mrs. MO, a 65-year-old female patient Hispanic with a history of obesity, with no other health problem, presented to the Primary Care office seeking to improve her lifestyle changes. Her goal is to lose 20 lbs. HT: 5’ 4”, Wt:180Lbs, BMI: 30.9 (Adult BMI Calculator), and for the high and weight, the weight should be 108-145lbs. (CDC, 2020). According to the Centers for Disease Control and Prevention, (2020) in an adult patient, the BMI is calculated at 30.9 which demonstrates that the patient is obese according to weight and height. Moreover, obesity can lead to chronic illnesses such as high blood pressure, diabetes, and high cholesterol due to poor diet and nutrition. Mrs. MO, 24 diet nutrition consists of every morning having bread, eggs over easy, home fries, and bacon, and aside from coffee, she also drinks a glass of orange juice. In the afternoon, for lunch, she can eat codfish with root vegetables and a glass of coke-cola.For dinner, she eats rice with beans, which can be fried chicken or steak, fried pork chop with sweet fried banana, or mashed potatoes. Mrs. MO grew up eating in a culture where this type of diet is normal and is passed on by their ancestors. Social activities consist of drinking occasionally and do not exercise and social activities are limited.

The U.S. Preventive Services Task Force (USPSTF) recommends that weight loss prevent obesity. Obesity can lead to morbidity and mortality in the adult population and recommended that clinicians suggest or refer adult patients with a BMI of 30 or higher to receive behavioral interventions. Recommendation Grade: B (USPSTF, 2018). Furthermore, obesity can lead to HTN, cardiovascular, prediabetes, and Type 2 diabetes screening is need it in adults who are overweight or obese. (USPSTF, 2017). The dietary CDC, and Dietary Guidelines for Americans (DGA) a healthy diet plan helps to follow an appropriate weight and BMI. A healthy diet includes eating all types of vegetables (dark green, broccoli, asparagus), fruits, grains, dairy (low fat, or fat-free milk), protein (lean meats, eggs, beans, peas, lentils, nuts, poultry), and oils (vegetable oils). Furthermore, limiting food high in sodium (less than 2,300 mg/day, added sugars (less than 10 percent of calories/day, and saturated fat (less than 10 percent of calories/day, and limiting alcoholic drinks. (CDC, 2022) & (GDA, 2020-2025).

Mrs. MO, during her lifespan, has practiced and believes that her eating habits are the best diet she can have since she does not suffer from any health problems but, facing obesity making it difficult for her to lose weight.After explaining to Mrs.MO the medical risks such as becoming hypertensive, prediabetic, or developing high cholesterol that can lead to cardiovascular disease since her weight should not be 180lbs instead should be around 140lbs. After her awareness of these consequences, she felt motivated to make a lifestyle change in her eating habits to prevent future health problems. She realized her poor eating habits have caused her to become obese. She verbalized back that she does not want to suffer from diabetes, HTN, or high cholesterol in the future. She will like to follow a plan recommendable diet that involves eating more vegetables, baking chicken instead of fried, rice once a week, fruits, grains, dairy fat-free milk, and protein, low sodium, low fat, and limited alcoholic drinks.

According to BMC Public Health, (2019) socio-economic studies have shown that individuals with high income have a higher probability to access supermarkets with higher levels of fruits, vegetables, and meat than does with low income. Those with a low income are exposed to and influenced by unhealthy food at fast-food restaurants because of the high cost and limited variety of fresh vegetables and fruits. What impacted me was how cultural beliefs can influence our eating habits and nutrition. I can understand and relate with Mrs. MO since I am also Hispanic, and I grew up eating the same food. Food preparation and high-calorie, a high-fat meal is a norm in our culture even though it is life-threatening. In addition, living in an area with many fast-food restaurants such as Burger King, & McDonald’s influences unhealthy eating habits growing up. Furthermore, a low-income household where the parents only have money to provide what they could because of poverty. That motivated me to finish high school and opt for higher education. I no longer eat the way I use to. Education helps me see things differently. Educating our patients can change their lives.

References

and B recommendations | United States preventive services Taskforce. (2017). United States Preventive Services Taskforce. https://www.uspreventiveservicestaskforce.org/uspstf/recommendation-topics/uspstf-a-and-b-recommendations

Dietary Guidelines for Americans. https://www.dietaryguidelines.gov/sites/default/files/2020-12/Dietary_Guidelines_for_Americans_2020-2025.pdf#page=31

Does access to healthy food vary according to socioeconomic status and to food store type? an ecologic study. (2019, June 18). BioMed Central. https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-019-6975-y

Healthy eating for a healthy weight. (2022, June 3). Centers for Disease Control and Prevention. https://www.cdc.gov/healthyweight/healthy_eating/index.html
Last review

Weight loss to prevent obesity-related morbidity and mortality in adults: Behavioral interventions. (2018, September 18). United States Preventive Services Taskforce. https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/obesity-in-adults-interventions

What is my BMI? (2020, September 17). Centers for Disease Control and Prevention. https://www.cdc.gov/healthyweight/assessing/bmi/adult_bmi/english_bmi_calculator/bmi_calculator.html

2nd discussion board 24 hour Food Collection for Mr. B

8 am – bread and coffee sometimes oatmeal

12 pm – 2 cups rice and chicken

3-4 pm – snack such as fruit, muffin, crackers or chips with dip

7 pm – rice and pork, rice and adobo, rice and chicken, sometimes left-over lunch

Dessert: ice cream

9 pm – peanuts and popcorn with soda

Bedtime: Multivitamin (Centrum Silver)

Water: 2 water bottles

Physical Activity: 1 hour walking every day

A 24-hour diet was collected on Mr. B, who is a 72-year-old male with no past medical history. Mr. B. starts his day around 8 am, and he informed me that he had bread with coffee first thing in the morning. He states that sometimes he will drink black coffee with some caramel syrup and will wait until lunchtime to finally have his first meal. However, yesterday he had his black coffee and toasted Filipino bread at 8 am. Around 12-1 pm he had 2 cups of steamed white rice with a chicken and potato stew. He reports that this is his usual routine and that at lunchtime, he will eat the rice he has previously steamed with either chicken, beef, pork chops or fish. Around 7 pm, which is his usual dinner time, he ate 1 ½ cups of steamed white rice with leftovers from lunch. He reports that when he does not cook dinner, he will order pizza or other fast food for dinner for him and his wife. After dinner, he states he always has his favorite dessert, an ice cream cone. When asked about his water intake, he informed me that he tries to drink water but sometimes forgets and on average will have 2 Poland spring water bottles which is around 16.9 oz.

The next step was to educate Mr. B on the current recommendations for his age group. Older adults should aim for a mix of foods from various food groups to reach daily nutritional goals (Klemm, 2020). A 72-year-old male should be eating around 2000 calories daily to maintain a healthy weight (My Plate, n.d.). Some unique needs for adults above the age of 60 are to include protein in their meals to maintain muscle mass (My Plate, n.d.). Mr. B was motivationally interviewed and encouraged to include more protein into his diet and he stated that he would try to make a boiled egg to add to his breakfast. Mr. B was also instructed to add more fruits to his diet since the United States Department of Agriculture (USDA) (n.d.) suggests that older adults should have 2 cups of whole fruits and 2 cups of veggies daily. A suggestion was made to Mr. B to incorporate more whole grains to his diet, and after encouragement he reported, he will try to add brown rice to his diet to replace white rice. The last suggestion that was made to Mr. B was to try to add more dairy to his diet, and he stated that he would try to incorporate the USDA’s recommended 3 cups of low fat or fat free milk and yogurt to his diet.

After Mr. B was able to communicate his concerns about his diet, he was much more open and agreeable to the changes that needed to be made. When Mr. B first started telling me about what he ate in 24 hours, he was educated right away on the recommended daily food groups that he should be eating in order to reach his daily nutritional goals. However, I realized that after conducting the 24-hour diet collection in this manner, he became very defensive and more closed off and started to lie about what he actually was eating. After I realized that he was being more closed off, we started having an open discussion about nutrition and his diet in general. When he was able to express his concerns financially about healthy food, he became more open about the foods he eats and was more accepting of the suggested foods he should be incorporating into his diet. Motivational interviewing was more effective with Mr. B for this 24-hour diet collection assignment because he realized that with some encouragement and education about which companies can deliver groceries to him and how to access coupons online, he was truly excited about adding more vegetables, fruits and grains to his meals daily.

This assignment taught me that having an open-ended discussion about a patient’s feelings and concerns about topics such as nutrition can allow them to be more open to teaching and lifestyle modifications. Mr. B informed me that he has been eating in a similar fashion for many years and at first was not agreeable to listening to the suggested dietary recommendations. However, he stated that he would definitely add at least more protein and vegetables to his diet since I was patient enough to teach him which applications/programs on the iPhone app store allow him to compare the prices of different grocery items such as fruits and vegetables. Every patient’s teaching requirement is different, and this assignment taught me that as future nurse practitioners and possible future primary care providers, we need to be mindful and aware of our patient’s willingness, readiness and acceptance to learn and be taught something new.

References

Gardener, S. L., & Rainey-Smith, S. R. (2018). The role of nutrition in cognitive function and brain ageing in the elderly. Current Nutrition Reports, 7(3), 139–149. https://doi.org/10.1007/s13668-018-0229-y

Klemm, C. S. (n.d.). Special nutrient needs of older adults. EatRight. Retrieved June 21, 2022, from https://www.eatright.org/health/wellness/healthy-a…

MyPlate. (n.d.). Older adults. United States Department of Agriculture. Retrieved June 21, 2022, from https://www.myplate.gov/life-stages/older-adults#:~:text=Unique%20Needs%20for%20Ages%2060%2B&text=Be%20sure%20to%20choose%20foods,dietary%20fiber%2C%20and%20vitamin%20B12.