Lean Doc Diaries #1

Some people may feel that the effort put into lifestyle improvement with focus on losing weight and preventing or treating their obesity and related comorbidities is a daunting task which is frustrating and maybe even impossible. I understand that the battle is tough one, but I want to convince everyone that it is possible to conquer your obesity and tremendously improve the related heart disease risk that comes with obesity. This blog entry is to go away from focusing on my personal lifestyle, but show the efforts and success of one of my patients who has made extraordinary strides in losing weight, disabling her diabetes, and improving her cholesterol and hypertension by following my instruction and taking our visits to heart, literally.

This story is about an obese female in her early 50s, with a family history of diabetes and subsequent heart disease. I first saw her about a year ago, and she expressed concern to me that she would like to lose weight and prevent diabetes and heart disease.

Patient Presentation

Upon initial examination of her and her labs, she was obese with a BMI (body mass index) of 33 with a weight of 190 lbs at 63.5 inches tall with an abdominal predominance (remember abdominal fat is visceral, and most correlated to cardiometabolic disease). Her blood pressure was elevated at 147/93 (stage 1 hypertension).

Her labs showed a fasting glucose of 109 which is consistent with “impaired fasting glucose” but her hemoglobin A1c (a lab test which essentially reveals the sugar caked onto red blood cells) was 7.9 which is diagnostic of diabetes (6.5 or greater = diabetes). Her cholesterol profile was significant for elevated triglycerides and non-HDL cholesterol which are subsequent to her visceral adipose obesity (visceral fat) and may lead to heart disease.

We discussed her obesity and the physiologic relationship to her diseases in depth. We talked about her current lifestyle which included poor dietary choices and minimal exercise. Although her diet was “normal” per our standards here in this country, she was quick to realize that she could make great improvements based upon what I was teaching her. She stated that she did not want to join a gym, but was excited to use her Wii video game system to enjoy exercise daily. She did want to avoid medications although I wanted to start her on a good regimen to treat her diabetes. We compromised that if she improved her blood sugars and hemoglobin A1c with weight loss, diet, and exercise then she would not need diabetic medication. I did advise her to begin a regimen of fish oil for primary prevention and to assist with weight loss and triglycerides.

Diet Prescription

I did not make specific recommendations for calorie counting, but per my usual, emphasized quality over quantity (Lean Diet Habits). She increased the proportion of vegetables in her diet while attempting to eliminate empty calories from starches, sugary drinks, and treats. She learned about low but good fat intake, and ate lean sources of protein with her meals.

Follow-Up / Success

She took my advice to heart and when she followed up with me 4 months later, she had lost 10 lbs, her A1c measured 6.2, and her blood pressure was down to 112/74! Her cholesterol profile lagged behind but improved slightly. Her most recent visit was exciting for her because her BMI was below 30 (30 is the definition of obesity) and her HbA1c was 5.8 (basically like a person without diabetes). Her blood pressure has continued to be normal and her cholesterol continues to improve.

By making these lifestyle modifications that we preach, she significantly decreased her chances of having heart disease in the short term along with all the other horrendous sequelae that come from obesity and diabetes. She is also much happier with the way she looks and feels. I will continue to positively reinforce these changes and improvements she has made while encouraging her to maintain this level of health and well-being, as it gives me a great deal of satisfaction to see her happy and disease free.

Let us all remember there is no secret to weight loss / fat loss. Compliance/Adherence along with strategy and simple education is the key to success. Stay tuned for other patient successes!