Health assessment: Margaret

Our nutrition and exercise expert looks at Margaret's eating and exercise habits and gives her some advice.

Subject

Margaret is a 69-year-old mother and grandmother. Since her retirement she has been very busy with her family, including caring for a special needs child. She provides accommodation and food for two boarders in her home. She is also involved with Kiwanas, a service organisation serving children.

• Age: 69 years
• Height: 1.63cm
• Weight: 99kg
• BMI: 37.2

Margeret's goals

• Improve general health
• Improve fitness

Margaret has always spent much time looking after other people around her and has been a support for all of her family. However, a string of bad health events recently has her looking to improve her lifestyle and health.

Margaret's current eating habits

• Breakfast: 2 slices of grainy bread with cholesterol-lowering margarine and Marmite. Sometimes a piece of fruit.
• Morning tea: Glass of water.
• Lunch: Most often a sandwich with tomato, lettuce and cucumber with margarine. Often up to three pieces of fruit. Occasionally a chicken sub-sandwich or tuna sandwich. Some days, if she is busy, she may skip lunch.
• Afternoon tea: Glass of water.
• Dinner: Some celery while preparing dinner. Usually about 120g (1 fillet) of meat, chicken or fish, about 1/3 cup of carbohydrate-containing food such as rice, pasta or noodles, and a few cups of vegetables. She uses an olive oil vinaigrette on her salads and other flavourings such as soy sauce and lemon pepper. Most often she also has two glasses of fruit juice.
• Dessert: A piece of fruit.

Margaret doesn't have tea, coffee or alcohol; she doesn't like them. She doesn't have many dairy foods in her diet (around 3 small tubs of yoghurt a week and no milk as she doesn't like it) and can have 4-5 litres of water a day. She eats a good mix of meats throughout the week with fish at least twice a week and uses a cholesterol-lowering margarine. She doesn't add salt to foods and enjoys a Thai takeaway once a week. Her intake has been constant for about the last month; before that she used to pick at biscuits and dried or fresh fruit, and have snacks between her main meals.

Margaret's current exercise regime

Up until six weeks ago, Margaret had been largely sedentary and had not done much exercise (except occasional walking). However, a few weeks ago she joined the breakthrough Never2old programme with AUT University. This programme is aimed at senior New Zealanders and incorporates exercises including resistance training, balance, flexibility and cardiovascular exercise in the gym.

Margaret's medical assessment

Margaret is on several medications to address cholesterol, blood pressure and asthma, which are monitored closely by her doctor. Her blood test results are clear including normalised blood cholesterol through her medication. Margaret has gained most of her weight since having her three children. 25 years ago she experienced severe asthma as well as skin allergies and was placed on a medication that increased her appetite, so she gained weight during that time.

Expert assessment

Kristen MacKenzie, health and nutrition consultant at Millennium Institute of Sport & Health, comments:

"There is always something that can be done to better one's own health, regardless of the circumstances. Although there are some negative affects of ageing, including decreased muscle mass and decreased energy needs, there is also so much to be gained by living well! Even more, these changes can be slowed or reversed in some cases by being active and eating well, part of the philosophy of the AUT Never2old programme. Bone density lowers with age, which creates an even greater need for calcium and vitamin D. It is important for older New Zealanders to have a good nutrient intake including plenty of fruit and vegetables, meat and alternatives, dairy foods and grains and cereals, despite often a decrease in appetite.

Margaret's history includes a five-year stint on prednisone (a corticosteroid/anti-inflammatory medication that has some side-effects including weight gain through increased appetite and water retention). This side-effect, coupled with multiple childbirths and lifestyle factors, has contributed to her current weight.

Her energy intake is currently very low – one would expect that she may lose weight on such a low-energy intake combined with exercise. However, Margaret has a few things to battle including a lowered metabolic rate (associated with aging and loss of muscle mass). I am reluctant to lower her energy intake much more because it will make it difficult for her to get the nutrients she needs, and I also feel that her body may have adjusted to this lower energy intake by slowing her metabolism. So we will be focusing on physical activity and general well-being. With an increase in muscle mass through her weight training, and by increased energy expenditure through extra physical activity, hopefully a gradual weight loss will occur.

Margaret – like many older New Zealanders – has a low fibre intake and a low intake of some critical nutrients, including calcium. I am particularly concerned about Margaret's calcium intake as she has had a low dairy intake throughout her life and at times has had done minimal exercise, which is important to increase her bone mineral density. Although her past can't be 'undone', through a good calcium intake and better habits, she can slow her bone mineral loss. Although Margaret has cholesterol and blood glucose in the healthy range, these are controlled by medications and lifestyle changes could potentially decrease her reliance on these."

Kristen's recommendations

Food

Breakfast. The same as she has now, but higher in nutrients; for example 1/2 cup muesli or porridge (with fruit) and vitamin C and D-enriched milk and yoghurt, or toast plus a piece of fruit.

Add some protein at lunch. For example soup (containing meat or lentils and veges) and toast, leftovers in small portions, or a grainy roll plus meat and salad. She should keep portions of dressings small or avoid them altogether.

Snacks. Yoghurt or dairy snack after training (or before if required) in the afternoon or if hunger sets in.

Dinner. Include lean meat (slightly smaller than her current portion) or lentils, 1/3-1/2 cup of cooked rice, pasta or potato and a minimum of 1 cup of vegetables. If she's hungry after dinner she should have a piece of fruit or a dairy-based snack or drink. No more fruit juice at dinner!

Margaret should continue to watch her snacking, however it is important she enjoys what she is eating as she may take a while to adapt to and get benefit from the changes.

Exercise

Resistance training, balance, flexibility and cardiovascular exercise in the gym a few times per week in the Never2old programme and walks most days.

Margaret's reaction

After two weeks

"I can do this… I have stuck to it pretty vigorously over the last few weeks and even though the weight loss is minimal, I am feeling much better both physically and mentally. I intend to stick to the plan and exercise as perhaps I am a slow starter and it will start to happen one day; anyway, the other results make it worthwhile. I have been walking most days at a reasonable speed to get me puffing which is good too."

6 weeks later

A medical diagnosis has affected Margaret; she has just been found to have osteoporosis (characterised by a 'thinning' of bones or a lowering of bone mineral density). This is very common in older New Zealanders. We had previously picked up that Margaret was at risk of osteoporosis due to a low calcium intake and low exercise levels. We can all learn from this; dairy intake is still sub-optimal in many age groups including young New Zealanders (some of whom are already showing bones that are a low bone mineral density).

Margaret weighs in at 98kg – 1kg less than when she started. Though it seems the weight loss is going to be a slow process, she reports she is feeling very positive with the changes and will continue to focus on her lifestyle because of the other benefits.

She's made another great achievement: Margaret set herself the goal to undertake a long bush walk. She was the oldest person in the group but coped very well with the walk; this was a major achievement in itself as Margaret was sure that she would not have been able to do a similar walk 6 weeks ago or recover from the walk as well as she did.

Margaret would like to continue her changes and hopefully she will gradually lose some more weight, but regardless of weight, her more active lifestyle and improved dietary intake – including improved fat intake and higher fibre (particularly soluble fibre) – will address her high blood cholesterol and high blood pressure. An increased calcium and vitamin D intake will help in slowing any further bone deterioration.