DC5 - NUTRITION MANAGEMENT & STRATEGIES FOR PREPARATION OF BARIATRIC SURGERY : A CASE STUDY IN DIETETIC OUTPATIENT CLINIC Muhaini Mahmud

Muhaini M1, Zahara AM1, Roslee R1

 

 1 Dietetic Program, Faculty of Health Sciences, Universiti Kebangsaan Malaysia

 

Assessment

Client history:

 

A 47 years-old Malay lady

A single mother and stays with her 3 children.

Occupation:clerk.

Family history : diabetes mellitus, hypertension & heart disease.

  

Anthropometric:

Weight=149kg, Height=168 cm, BMI=52.8kg/m2(morbid obesity). 

Lowest adult weight=85kg (in age of 20’s). 

Weight was stable in the past few years and experienced weight loss >10 kg (2005) due to personal problems but regained. 

 

NFPF: Bilateral knee pain due to osteoarthritis, epigastric pain and bloatedness.

 

Diet History/Exercise: Estimated energy intake : 1700 to 2200 kcal/day. She tended to snack on large portion size and high calorie foods because of gastritis. No exercise due to knee pain.

 

Readiness to change: She was in the preparation stage for change. From the readiness to change scale: score of 8 for importance, 8 for confidence & 9 for readiness to change.

 

Diagnosis

Obesity related to excessive energy intake and physical inactivity as evidenced by BMI > 40kg/m2, frequent intake of large portion size of foods, high calorie density foods and sedentary lifestyle.

 

Intervention

1200 kcal/day low calorie diet.

Education on energy balance concepts, mindful eating habits and ways to avoid gastritis attack.

Advised to reduce high fat foods and portion sizes of foods.

Advised to start doing a food diary and sample menu was given.

Monitoring & Evaluation

-Monitor weight changes and diet adherence

-KIV for VLCD

  

Outcome & follow up:

 

1st follow-up : 2 weeks.

No lifestyle changes due to time constraints.

OGDS: GERD and Hiatus Hernia Type 1.

Operation date : in 2 months' time

Reinforced on 1200kcal/day low calorie diet : self-monitoring - food diary and record weight weekly.

 

2nd follow-up: 1 month.

Moderate adherence to dietary advice.

Weight loss: 4.8 kg.

From the food diary: reduced the portion size of foods but selection of foods still high in fat.

No more epigastric pain or bloatedness.

Explained on a very low calorie diet (VLCD)