Physical Measures
Wt=90.4kg
Biochemistry
Urea, Creatinine & Electrolytes – normal
Full Blood Count - normal
BGL measured on ward daily
0600hrs fasting: 5.1-6.5
1230hrs before lunch: 6.0-7.0
1800hrs before dinner: 5.3-6.7
2000hrs: 8.3-9.7mmol/L
Mr Tanner’s biochemistry results and BGL were virtually unchanged. He is achieving a good rate of weight loss (recommended rate of loss =0.5-1.0kg/week). Waist circumference is measured monthly (recommended rate of loss =1-4cm/month). It is likely that Mr Tanner’s BGL/lipids will not improve until he loses further weight e.g. at least a 5-10% loss.
The dietary plan/information for Mr Tanner was reviewed with Mr and Mrs Tanner. Mrs Tanner is still keen to cook the prescribed diet at home, but has kept the meals on wheels information in case she needs this in the future. Mr Tanner is looking forward to a beer when he gets home, but has agreed to restrict this to <2 standard drinks/day and to include at least 2 alcohol free days per week. He was disappointed at what he perceived as a slow rate of weight loss, so I reassured him that a loss of losing 0.5-1.0kg/week is a good rate of loss and that it is best to focus on eating and activity goals rather than weight-related goals. I have provided handover to the local dietitian in his area so he can continue to receive dietetic input after discharge.
Dieraty issues discussed/sheets provided include:
1) Soft diet options
2) Reducing salt intake (processed foods, label reading, etc)
3) Increasing vegetable intake at lunch, dinner and snack times
4) Reducing saturated fat intake (meat fats, dairy fats, processed foods)
5) Reducing total fat (restrict amounts of olive/canola oil in cooking, sterol based margarine, avocado, nuts, etc)
6) Eating fish 2-3 times per week and taking 4x regular fish oil capsules daily to lower triglyceride levels and reduce cardiovascular risk
7) Reducing sugar intake (no sugar containing beverages, desserts, etc)
8) Low glycaemic index CHO choices (sweet potato, porridge, etc)
9) Limit alcohol intake to ≤2 standard drinks per day for men and include at least 2 alcohol free days per week
10) Initial weight target is 5-10% loss (to 81-85kg) at 0.5-1.0kg/week and a waist circumference loss of 1-4cm/month
Note Mr Tanner dislikes snacks and eats his main meal at lunchtime.
Click here to see Mr Tanner's sample Meal Plan 6000kJ (1500kcal)
