You have a patient, “DR” that wants to lose weight. He is 44 and weighs 210 lb a
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Question
You have a patient, “DR” that wants to lose weight. He is 44 and weighs 210 lb and is 6’ 4”. According to the Body Mass Index graph on p.4, is he overweight? _______________What is the main composition of the excess weight? a. muscle (protein) b. adipose tissue (fats) c. glycogen (carbohydrates)Estimate the calorie deficit needed to lose 10 pounds of the above excess weight below.1 lb. = 454 grams. Adipose tissue is about 85% fat and 13% water. Fat is 9 Cal/gram.1. Grams of fat in 1 pound of adipose tissue = 454 g x 0.85 = __________grams of fat.2. Calories in 1 lb of adipose tissue is ___________grams of fat x 9 Cal/g = ____________Cal/lb3. Calories in 10 lbs of adipose tissue is _______________ Cal/lb x 10 lbs = ______________TotalTo conserve body protein, this weight should NOT be lost faster than 2 lbs per week, or less.Assume the goal is to lose 10 lbs. in 10 weeks or 70 days.4. Take the Total calories in 10lbs, _________________Cal divided by 70 days = __________________ Cal that must be lost per day.5. Looking at his diet, “DR’s 24 Hour Dietary Recall” his total intake is _______ Cal/day. On a Table for active Men under age 45, the estimate is Maintenance= 15 Cal x 200lbs = _______On a Table for less active or over age 45, the estimate is Maintenance= 13 Cal x 200lbs =_______Eating 3460 Cal /day, do you think he is gaining or losing weight?Are we in the right “ball park” for number of daily calories for DR now?_____ When older?____How do we find out what is the “right” number? (Has to do with a scale, weighing ourselves..!)Rapid weight loss leads to losses of body protein, muscle, in addition to fat and occur on “Crash diets” that encourage losses over 2 lbs of body weight a week. 1 lb. of protein is 28% protein, and 68% water.6. Grams of protein in 1 lb of muscle = 454 grams x 0.28 = ________ grams of protein.Protein is 4 Cal / gram so Calories in 1 lb of muscle tissue is ___________grams x 4 Cal/g = ____________Cal/lb muscleNote that most of the weight lost is from the water lost, 454 grams x 0.68 = ________gramsThis is an oversimplification as both adipose and lean tissue mass would be lost during any Calorie deficit plan, but this illustrates why a“Crash Diet” with too few calories in every category doesn’t improve body composition even though you lose “weight” fast. Describe 2 ways to spare lean body tissue during a diet: ___________________________________________________________________________________________________________________________ 7. Looking at his diet, “DR’s 24 Hour Dietary Recall”, do you see some areas where he can cut calories? Name some general things he can do to decrease his calorie intake per day:How is his balance of proteins, carbohydrates and fat? Good Basically O.K. Bad8. He has decided to ignore your advice and go on a high protein, high fat, low carbohydrate diet. He feels tired now, but is losing wt. You do a U/A and you find ketones. What do ketones mean?On a blood chemistry, his glucose is 89 mg.dl and his BUN is 30 Creatinine 0.9 HCT 44% Na 147 mEq Is he dehydrated? ________________In this case, what does a high BUN indicate? ______________________________What energy source is he using to make his glucose?____________________Many weight-loss experts advise that people should use a general guideline of 50% carbohydrates, less than 30% fat and 20% protein to equal 100% of diet. And people are following those guidelines but we are gaining weight because of poor “portion control”. Example: 50 years a go, a bottle of soda was 8 ounces and about 100 Calories. Then cans of soda were made and they were 12 ounces, and about 140 Calories Training our sweet tooth!Now, it is common for a bottle of soda to be 20 ounces, and about 240 Calories. Yikes! 9. What food items could DR keep in his diet, but change his portion size to reduce his intake?10. What food items could DR keep in his diet, but change how they are prepared? Hint- Chinese food? Wok did you say?
Explanation / Answer
1. You have a patient, “DR” that wants to lose weight. He is 44 and weighs 210 lb and is 6’ 4”. According to the Body Mass Index graph on p.4, is he overweight?
= General formula to calculate BMI is
BMI = 703 x (weight in lb)/(height in inch)2 = 703 x (210 / 762) = 25.56 kg/m2
For a 44 years person this signifies Overweight.
2. What is the main composition of the excess weight?
The main composition of the excess weight is - b. Adipose tissue (fat)
The excess weight is composed of fat, over lean mass that is only protein. The extra calories from food that the body does not burn are stored into our adipose tissue as fat.
3. Estimate the calorie deficit needed to lose 10 pounds of the above excess weight below.
= 1 lb. = 454 grams.
Adipose tissue is about 85% fat and 13% water.
Fat is 9 Cal/gram.
i.) Grams of fat in 1 pound of adipose tissue = 454 g x 0.85 = 386 grams of fat.
ii) Calories in 1 lb of adipose tissue is 386 grams of fat x 9 Cal/g = 3474 Cal/lb.
iii) Calories in 10 lbs of adipose tissue is 3474 Cal/lb x 10 lbs = 34740 cal Total
To conserve body protein, this weight should NOT be lost faster than 2 lbs per week, or less. Assume the goal is to lose 10 lbs. in 10 weeks or 70 days.
iv). Take the Total calories in 10lbs, 34740 Cal divided by 70 days = 496.3 Cal that must be lost per day.
v) Looking at his diet, “DR’s 24 Hour Dietary Recall” his total intake is 3460 Cal/day.
On a Table for active Men under age 45, the estimate is Maintenance= 15 Cal x 200lbs = 3000 Cal.lbs
On a Table for less active or over age 45, the estimate is Maintenance= 13 Cal x 200lbs =2600 Cal.lbs
4. Eating 3460 Cal /day, do you think he is gaining or losing weight?
= For an person of 44 years he should be eating same or less of 3000 cal per day. But his daily intake is 3460 cal. So he is gaining weight.
5. Are we in the right “ball park” for number of daily calories for DR now? No
6. When older?
7. How do we find out what is the “right” number?
Regularly weighing himself and calculating his daily intake by calculating caloric values of the food. Consuming a little less than the daily recommendation caloric intake will help him get the 'right' number.
8. Rapid weight loss leads to losses of body protein, muscle, in addition to fat and occur on “Crash diets” that encourage losses over 2 lbs of body weight a week.
1 lb. of protein is 28% protein, and 68% water
vi). Grams of protein in 1 lb of muscle = 454 grams x 0.28 = 127.12 grams of protein
Protein is 4 Cal / gram
So Calories in 1 lb of muscle tissue is 127.12 grams x 4 Cal/g = 508.5 Cal/lb muscle
Note that most of the weight lost is from the water lost, 454 grams x 0.68 = 308.7 grams
This is an oversimplification as both adipose and lean tissue mass would be lost during any Calorie deficit plan, but this illustrates why a“Crash Diet” with too few calories in every category doesn’t improve body composition even though you lose “weight” fast.
9. Describe 2 ways to spare lean body tissue during a diet:
Two ways to reduce weight without loosing lean mass is:
a) by not allowing fast lost of weight. A gradual lost of excess mass will ensure that the fat is burning and not the protein mass. Exercising a right amount is always preferable. Cardiac output increasing exercise will help burn more fat.
b) by eating right food. Consuming very less carbohydrate which are easily digestable is very helpful. Also consuming hard to digest carbohydrate like fibres from plant is preferable. A proper amount of protein also needs to be taken, 8 grams per body weight in Kg. No unhealthy fat should be taken.
10. Looking at his diet, “DR’s 24 Hour Dietary Recall”, do you see some areas where he can cut calories?
[This answer requires a provided diet table that is not included in this question]
11. Name some general things he can do to decrease his calorie intake per day.
12. How is his balance of proteins, carbohydrates and fat?
[This answer requires a provided diet table that is not included in this question]
13. He has decided to ignore your advice and go on a high protein, high fat, low carbohydrate diet. He feels tired now, but is losing wt. You do a U/A and you find ketones. What do ketones mean?
= Ketones are the end product of fatty acid metabolism. Acetone, Acetoacetate and beta hydroxy butyrate are the three ketone produced in our body. These are excrete through urine. When high protein is taken excess protein is converted to fat. Along with high fat in diet this excess proteins converted into fat produces more ketone than usual. But as he is exercising he is burning energy and he is loosing lean mass. So he is feeling tired although he is loosing weight.
14. On a blood chemistry, his glucose is 89 mg.dl and his BUN is 30, Creatinine 0.9, HCT 44%, Na 147 mEq Is he dehydrated?
= A Blood Urea Nitrogen (BUN) to creatinine ratio should be between 10:1 to 20:1. For him it is 33:1. An excess BUN to creatinine ration indicates dehydration. So he is dehydrated.
Also his Hematocrit (HCT) on the lower range, means he has less RBC. And his sodium concentration is higher. This also indicates that he is dehydrated as excess sodium is not excreting through urine as very less water in the blood.
15. What energy source is he using to make his glucose?
= [This answer requires a provided diet table that is not included in this question]
Many weight-loss experts advise that people should use a general guideline of 50% carbohydrates, less than 30% fat and 20% protein to equal 100% of diet. And people are following those guidelines but we are gaining weight because of poor “portion control”. Example: 50 years a go, a bottle of soda was 8 ounces and about 100 Calories. Then cans of soda were made and they were 12 ounces, and about 140 Calories Training our sweet tooth!Now, it is common for a bottle of soda to be 20 ounces, and about 240 Calories. Yikes!
16. What food items could DR keep in his diet, but change his portion size to reduce his intake?
=He can take Rice, Spaghetti, potato etc like high carb containing foods but in reduced amount. Also no fried food.
[Please refer to the given diet table of that person to write this answer properly]
17. What food items could DR keep in his diet, but change how they are prepared?
= Foods that are prepared with high heat or high spices should be avoided. Also sugar intake via food items should also be avoided.
[Please refer to the given diet table of that person to write this answer properly]
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