Health assessment: Prue

Our nutrition and exercise expert looks at Prue’s eating and exercise habits and gives her some advice.

Subject

Prue is a business liaison manager in a community firm. She has a busy lifestyle including many corporate and social functions and lives with her adult sons and partner.

• Age: 51 years
• Height: 1.65m
• Weight: 99kg
• BMI: 36.4 (this puts her in the obese category; healthy weight range is 18.5-25)
• Waist circumference: 119cm (high risk)

Prue’s goals

• Weight loss
• Regular exercise
• Feel good

At 51, Prue has been finding it really difficult to juggle a range of commitments including her family, her work and other continual distractions! Over time this has compounded into an increasing waistline. She feels it is time, in her words, to “put herself first”.

Prue’s current eating habits

• Breakfast: Weet-Bix and blueberry muesli with 1/2 pottle of yoghurt (light), cream and 1/2 tin fruit in juice or egg on toast/peanut butter on toast (1 piece).
• Morning tea: Trim latte and banana. Sometimes (at least once a week) morning tea at work includes sausage rolls, pies and a range of treats.
• Lunch: Ham and salad sandwich or pita bread, frittata, or sushi at least twice a week. Sometimes lunches are provided for a work function with a range of foods.
• Afternoon tea: Apple occasionally, yoghurt more often and hot chocolate is a favourite in the cold months!
• When she gets home: A glass of wine (or more); paté, hummus and cheese with crackers most days (carrot sticks with dips occasionally).
• Dinner: Normally about 300g of meat, 2 cups of vegetables and a cup or so of pasta, noodles or rice. This can include stir-fries, spaghetti bolognese or burgers. Also takeaways up to three times a week including pizza, BBQs or Thai.
• Dessert: Low-fat frozen dessert on occasion or a few sweet biscuits most nights.

Prue tries to have 2-3 pieces of fruit per day. She loves eggs and has up to 5 per week and enjoys diet soft drinks. She has 3-4 teas or coffees per day, which are often in meetings. She tries to purchase low-fat, brand name products where possible and tries to cook most of the time with low-fat cooking methods. She does have a self-confessed sweet tooth and finds it hard to say no to the fatty, salty treats that are offered up at work! She also enjoys a wine (or a few) most evenings and with corporate functions.

Prue’s current exercise regime

For the last 2-3 years her exercise programme has been nothing and prior to that she did the occasional walk. Her VO2 max or cardiovascular fitness score is 28.5ml/min/kg (low). Prue admits she hates exercise and if left to her own devices will avoid it at all costs. However, she is sick of feeling breathless after climbing a few stairs or a small exertion. Prue has recently started with a personal trainer.

Prue’s medical assessment

A thorough medical assessment alerts Prue to how her habits are starting to affect her health. Her total cholesterol is high at 6.4mmol/L (reference <4.0mmol/L) which is mostly from a high LDL reading (the bad cholesterol) at 4.3mmol/L (reference <2mmol/L). Her total ratio of LDL/HDL is high at 4.9mmol/L (reference <4mmol/L). Her BMI and waist circumference also suggest she is at a high risk for other medical conditions, including type 2 diabetes.

Expert assessment

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

Prue is ready to make the change. She feels that she needs to put herself first, and the rest will follow. She has good food knowledge and starts the day off quite well, but then she may be too busy to eat at suitable times and is often tempted by the range of snacks offered to her at work. By the time she gets to the afternoon she is exhausted and is playing catch-up with her food, so she tends to snack and drink through the evening.

Prue has started to feel some of the effects of her lifestyle; some of the obvious effects include difficulty breathing on physical exertion and joint problems. We have now uncovered her high cholesterol levels and we can only speculate some of the other effects her lifestyle will be having on her health and stress levels.

I am concerned that her saturated fat intake is high and her total energy intake is high. In many ways, however, we just have to tweak her eating habits and it is the exercise that is going to make all the difference!

Recommendations

Food

Fix up the meals: Firstly, take out the cream at breakfast! I want Prue to try and include a small protein serve in her lunch each day to help fill her up, and also enjoy low-GI carbohydrate-containing foods. She should aim for a minimum of 1.5 cups of veges at both lunch and dinner and also include a small amount of unsaturated oil in her meals, whether from some nuts in her salad, vegetable oil for cooking or hummus on her roll. Smaller meat serves at dinner are important (approx 150g instead of 300g).

Plan: Prue needs to plan her eating for the day – if she knows she has a corporate lunch or morning tea where there won’t be anything suitable to eat, she should ensure she has some snacks available. Otherwise the 80:20 rule may help: her snacks at events should be healthy options (eg small sandwiches and fruit), and other items (such as sausage rolls and pastries) should make up less than 20% of what she chooses.

Schedule appropriate snacks: Prue should add in a small, healthy snack during the morning such as a piece of fruit, and schedule an afternoon snack such as some toast with spread (low-fat), low-fat crackers, yoghurt or fruit. She should enjoy low-energy foods for an afternoon nibble when she gets home, but limit her portion to a small plate size. Good choices could be dry-popped popcorn, vege sticks or some rice crackers with salsa.

Address the alcohol, takeaways, drinks and dessert! Prue should limit her wine intake where possible to the weekend, or when at corporate functions to one or two glasses. For dessert she should try chai, herbal tea or low-energy desserts. I don’t mind the occasional coffee at a function but she should limit sugar and cream varieties. She can enjoy one or two low-fat cookies or even the odd square of chocolate! With lifestyle change, no foods should be forbidden, just eaten in the right amounts.

Exercise

Prue’s personal trainer gives her a programme that is mostly based on cardiovascular exercise; kilojoule-burning exercise that gets your heart rate up! She also includes some light weights, but in Prue’s particular case the main focus will be on getting her moving. She is given a variety of options for cardiovascular exercise including cycling or walking (on the treadmill) in the gym, walking hills and flats, and cycling at home as she has her own exercise bike. The programme includes up to 6 sessions per week, with two each week with her personal trainer to further motivate her, assess progress and push her to her limits!

Prue’s reaction

After 2 weeks

“A big thing for me is thinking about what I ‘actually need’ and what I just ‘do by habit’. Also with food it is great to take the time to prepare it nutritionally and sit down and enjoy it. Kristen and the team have helped me through the guilt I was feeling for putting my own priorities first and to value myself. With my meals, I have started planning ahead and going shopping with a list in front of me and I am not really getting tempted too much from the other foods, as I am still able to have small amounts – even at work. Kristen has got me to write some goals and give myself a non-food related reward, which has been an interesting exercise.”

6 weeks later

Amazing! Prue is buzzing! She weighs in at 94.5kg – that is 4.5kg less than where she started! She reports she is feeling great, her energy levels are through the roof and she doesn’t experience peaks and troughs any more or feel tired after a workout. She finds her exercise is now a habit. In her words, if she doesn’t do it every second day she “gets cranky”. There was a moment when she felt like some fries and purchased them; she found she didn’t want them, they tasted horrible and she threw them away. She also notes that her stress levels have lowered.

To achieve this, she has cut her alcohol intake by half and her kilojoule intake is lowered by about 2,000kJ per day (that is the right amount to lose approximately 1/2-1kg per week). Her total fat intake has almost halved, mostly from a lowering of saturated fats (the bad fats) in her diet. She still finds she struggles to meet the suggested amounts of fruit and vegetables but sees that this can be her next step as she has already changed so much. Her waist measurement has dropped a few centimetres to 116cm, suggesting she is losing weight from a very important area – that high-risk area around the stomach.

Interestingly we have seen a slight rise in Prue’s cholesterol results. While she had a positive increase in her HDL (protective cholesterol) levels, she also got a rise in her LDL (bad cholesterol) levels. This can happen with substantial weight loss, as stored body fat has a high concentration of saturated fats. When it is mobilised to burn for energy (as is happening in Prue’s case), this can lead to increases in LDL. In some people it can take up to three months to stabilise. Prue’s ratio of these two types of cholesterol is still exactly the same, which indicates that there is not an increased risk by this temporary raise in LDL levels.

Her cardiovascular fitness has improved substantially. From an original VO2 max result of 28.5ml/min/kg she has a new result of 36.1ml/min/kg. This is a fantastic result – bringing her from the low to average range. She is also noticing she is not breathless any more on the stairs!

The six weeks have presented a life ‘turn around’ for Prue and she looks forward to continuing her learning and journey.

A few months on…

Health assessment follow-up: Prue