Case Study: Lifestyle Changes for Weight Control
Sally is a 43-year-old mother of two who has gained 50 pounds over the past 5 years. She is 64 inches tall and weighs 180 pounds with a BMI of 31. Her waist circumference is 37 inches. She acknowledges that she is not as physically active as she would like to be. She also notes how recent stresses in her life have affected her sleep and seem to have triggered her appetite for sweets and comfort foods. Sally’s father recently died from complications of type 2 diabetes, and her mother and sisters are overweight. Sally says she is very motivated to “not get diabetes” and is disturbed that her recent physical exam revealed mildly elevated blood pressure, glucose, and cholesterol levels.
1. Looking at Sally’s health information, you need to tell her about all of the following health risks to encourage her
to lose weight. Which health risk is incorrect?
a. Sally’s 37 inches waist size indicates central obesity, which increases the risk of heart attack and stroke.
b. Her BMI of 31 indicates that she is just slightly overweight.
c. She is at increased risk of developing diabetes because she now has mildly elevated blood glucose levels and her
father had type 2 diabetes.
d. Her mildly elevated blood pressure increases the risk of hypertension in the near future, and hypertension is a
major risk factor for heart disease.
2. Sally stated that recent stresses in her life are affecting her sleep and seemed to have triggered her appetite for sweets and comfort foods. Which of the following statements would be best to explain why her lack of sleep has increased her appetite?
a. The satiety hormone leptin increases with lack of sleep.
b. Lack of sleep decreases ghrelin levels.
c. Levels of Neuropeptide Y, a brain chemical that causes carbohydrate cravings, are high and are causing her sleep
d. Lack of sleep increases levels of ghrelin, which stimulates appetite and decreases levels of leptin that decreases
3. Sally has been told that she most likely has gained weight from having a higher percentage of white adipose tissue, due to inefficient uncoupling proteins. What would you tell her?
a. White adipose tissue releases heat and burns fat, so that is not a reason to gain weight
b. It is her lack of sleep that is increasing her white adipose tissue; better sleep would decrease white adipose tissue
c. Exercise would be beneficial to help produce a “browning” effect on white adipose tissue by producing fat cells
known as “brite adipocytes”, therefore decreasing white adipose tissue percentage.
d. Drinking large amounts of fluid would decrease white adipose tissue percentage.
4. Sally believes that it is predominately genetics that has caused her to gain weight. You inform her obesity reflects the interactions between genes and environment. All of the factors surrounding a person that promote weight gain, such as increased food intake, especially of unhealthy choices, and decreased physical activity is known as:
a. overabundance syndrome
b. obesogenic environment
c. surplus environment
d. excessiveness syndrome
5. Sally’s friend, Monique, was morbidly obese and had gastric bypass to help her lose weight. Sally is considering surgery as an option. What does she need to know?
a. Only about 10 percent of the excess weight will remain lost after 10 years.
b. Bariatric surgery only reduces the size of the stomach; it has no effect on hunger hormones.
c. Bariatric surgery is only an option for those whose BMI ≥40 or BMI ≥ 35 with obesity-related health problems.
d. After surgery, eating patterns do not have to be changed.
6. Based on a reasonable weight loss of 5-10% of body weight over 6-months, what would be the weight loss goal
a. 2 to 5 pounds
b. 20 to 25 pounds
d. 9 to 18 pounds
e. 25 to 35 pounds
7. Energy density is defined as the energy, or kcals, provided per gram in a food. Sally needs to learn about the
importance of selecting low-energy-density foods that provide more satiety for fewer kcalories. Which of the
following breakfast options would be best? Note: Most of the breakfast options contain the same number of
a. 16 oz cappuccino, one bran muffin
b. 1 donut with cream filling, 8 oz orange juice, coffee with 2 Tbsp of half and half
c. ½ cup of granola cereal, ¾ cup low-fat milk, 8 oz orange juice
d. Breakfast burrito made with a small tortilla, 2 eggs, 1 Tbsp shredded low-fat cheese, peppers, onions,
1 oz avocado, one cup strawberries, 6 oz low-fat yogurt
8. Applying the same principles as described in Question 7 what dinner option would be best for Sally?
a. 1½ cups Chicken Alfredo with 1 slice garlic bread, 2 cups Caesar salad, ½ cup berry parfait
b. 1½ cups Spaghetti with red sauce, 2 cups tossed green salad with 1 Tbsp low-fat Italian dressing, ½ cup kiwi
c. 2 cups Chicken Tortilla Soup, made with ½ cup chopped chicken, ¼ cup corn, pepper, and onions and topped with
4 baked tortilla chips, crumbled; 1 cup spinach salad with vinaigrette dressing; 6 oz low-fat Greek yogurt
d. 6 oz Chicken Wings with barbeque sauce, ½ cup corn, 1 cup melon cubes, 1 c green salad with oil and vinegar
9. Sally stated that she is sedentary. You need to convince her that in addition to following a diet featuring
low-energy-density foods, she also needs to incorporate 200 to 300 minutes of moderately intense physical activity per week. The benefits of combining diet and physical activity together include all except the following point:
a. Those who lost weight by diet and exercise lost more body fat compared to those who only followed a
b. Those who lost weight by diet and exercise retained more muscle compared to those who only followed a
c. Those who lost weight by diet and exercise regained less weight compared to those who only followed a
d. Combining diet with exercise does not reduce stress.
10. A key part of successful weight management is behavior modification. You have recommended to Sally to set
“SMART” goals which include:
a. Specific, Manageable, Achievable, Reactive, Time based
b. Selective, Manageable, Activity based, Relevant, Temporary
c. Specific, Measurable, Attainable, Relevant, Time based
d. Selective, Measurable, Attainable, Reactive, Taste based