Case 991: Richard
Richard M. is a 60 year old salesman for company that makes adapters for industrial power tools. His sales area is the northeast including all of the New England states, New York and Pennsylvania. He spends much of his time in his automobile traveling to visit clients.

He has come to see you today to have his blood pressure checked. You have been treating him for mild hypertension and his blood pressure has been well controlled with Prinivil.

Richard also states that he is having a lot of problems with constipation. He says his wife told him to eat some bran in the morning for his constipation. He tried that for three or four days, but the constipation got so bad he had to go to the emergency room to get "cleaned out". The doctor at the hospital told him that he had hemorrhoids and that he should avoid getting constipated. Because his mother always used to give him mineral oil as a laxative when he was a child, Richard has picked some up at the drug store, but he hasn't tried it yet.

He continues to have some difficulty urinating due to benign enlargement of the prostate which you have been monitoring for the last five years. Richard admits to limiting his fluid intake so he won't have to stop so often when he is traveling.

He says he knows he weighs too much, so he has been trying to follow a diet. He admits that he's always hungry on the diet and he frequently cheats. He has been overweight for about thirty years. He now weighs 245 pounds and is 5'11" tall. He has been on and off diets and exercise programs with varying degrees of success. His lowest weight that he can remember was 190 pounds at his wedding twenty eight years ago. He has been "on the diet" for about two weeks but hasn't lost any weight.  When he is on the diet, he tries to eat dry toast and black coffee for breakfast and a piece of fruit for lunch.  He thinks he probably overeats at dinner because he is so hungry

Richard was adopted as an infant and does not know anything about his biological parents.

When he is traveling, Richard usually has a muffin and juice for breakfast, a sandwich for lunch and frequently for dinner too. He always has a drink (alcoholic) with dinner to help him relax. He eats all of his meals in restaurants.

Physical Exam is unremarkable except for obesity and palpable internal hemorrhoids.  BP  is 135/90. Laboratory results are within normal limits except for a serum cholesterol of 215 mg/dl.


Treatment:

Goals: Ideal Body Weight

Diet:
Energy Requirements

Composition
Meal plan

Exercise: