Case Studies

Part 1

R.A. is a 50 year old female who comes to you for dietary counseling because her sister recently had a heart attack. She is 5’4″ tall (64″,163cm) and weighs 175 lbs. (80kg). Yesterday she says she ate for breakfast: scrambled eggs, toast, milk, and orange juice; for lunch: a hamburger and fries; for dinner: steak, rice, salad, bread, and milk.

Question 1: What is her ideal body weight? Is she obese? What is her body-mass-index and is it abnormal? What would you estimate for her resting energy expenditure and recommended daily intake of energy with light exercise? What would you estimate her daily dietary intake to be? What is wrong with the dietary history you have and what else would you want to know? How would you counsel her?

• Ideal body weight can be estimated for adult males by 110 lbs. plus 5.5 lbs. for every inch above 5′, for adult females by 100 lbs. plus 5 lbs. for every inch above 5′, so her ideal body weight is 100+ (5×4) = 120 lbs. She is more than 20% (24lbs.) above ideal body weight, and therefore obese. Body mass index is weight (kg) divided by height (m) squared or 80/(1.63×1.63)= 30 kg/m2 , with 20-25 being ideal, over 27 overweight and over 30 obese. The Harris-Benedict equation gives her Basal metabolic rate as 655 + 9.5(kg) + 1.8(cm) – 4.7(yrs) = 1500 kcal/d x 1.5 = 2250 kcal for light activity.

Part 2

Unfortunately, her diet history does not give amounts eaten, snacks, condiments (such as sauce, gravy, butter, and jams), desserts, which would easily add up to more than the 2250 kcal suggested to maintain weight. Obese patients are well-known to underestimate their measured dietary intake by 20% or more. As little as 200 kcal/d (a candy bar, soft drink, or doughnut) extra would theoretically add up to 18 lbs. weight gain over a year. Some dietary suggestions would be to eat less fast foods, less fried foods, more fruits and vegetables, 1% low-fat milk or calcium supplements, and regular exercise. Laboratory assessment may include a CBC, cholesterol, fasting triglycerides and lipoproteins.