With a height of 168cm and weight of 76kg, Mrs Scott’s BMI is 28, indicating that she is overweight. Weight reduction is likely to have a significant impact on her experience of arthritic pain. I have asked her to keep a two week food diary and to see me again at the end of this period to discuss any necessary dietary changes.

After examining Mrs Scott’s food diary, it is apparent that there is certainly some room for improvement.  At present she is having a cooked breakfast every second day and toasted muesli and/or a croissant every other day.  These foods are high in fat and sugar.  I have advised Mrs Scott to convert to natural muesli with fresh fruit and yoghurt, rather than the toasted variety.  A cooked breakfast once per week is acceptable, but portion size needs to be reduced.

I have advised Mrs Scott to gradually replace sweet biscuits and cakes with fresh fruit, nuts, yoghurt, and other healthy and/or wholegrain snacks.  Soups, salads and sandwiches make excellent easy lunches, but she needs to be careful with luncheon meats, dressings, cream and mayonnaise.

Adequate dairy intake is essential for Mrs Scott given her family history of osteoporosis, restricted mobility and experience of recent falls. She should ideally have three serves of dairy each day, including low fat milk, yoghurt and cheeses such as ricotta or cottage. Oily fish with bones will also provide extra calcium.

The Scott’s presently eat too much red meat and very little fish. I have advised them to increase the level of omega 3 fatty acid in their diet by eating at least three fish meals per week for health and to aid in arthritic pain relief.  Red meat is fine 1-2 times per week but the portion size should not exceed 100g (palm size). A variety of fresh, raw or slightly cooked vegetables and low GI carbohydrates are also essential.

Mr and Mrs Scott eat out regularly with friends and we have discussed healthy food choices.  Portion size is also an issue for Mrs Scott and we have talked about alternatives, such as ordering an entrée size pasta and green salad.

Mrs Scott plans to maintain her regular exercise regime and with improvement in her symptoms of incontinence, will be more comfortable taking up regular swimming and water aerobics again.