R.A. is a 50 year old female who comes to you for dietary counseling because her sister recently had a heart attack. She is 5'4" tall (64",163cm) and weighs 175 lbs. (80kg). Yesterday she says she ate for breakfast: scrambled eggs, toast, milk, and orange juice; for lunch: a hamburger and fries; for dinner: steak, rice, salad, bread, and milk.
Question 1: What is her ideal body weight? Is she obese? What is her body-mass-index and is it abnormal? What would you estimate for her resting energy expenditure and recommended daily intake of energy with light exercise? What would you estimate her daily dietary intake to be? What is wrong with the dietary history you have and what else would you want to know? How would you counsel her?
Unfortunately, her diet history does not give amounts eaten, snacks, condiments (such as sauce, gravy, butter, and jams), desserts, which would easily add up to more than the 2250 kcal suggested to maintain weight. Obese patients are well-known to underestimate their measured dietary intake by 20% or more. As little as 200 kcal/d (a candy bar, soft drink, or doughnut) extra would theoretically add up to 18 lbs. weight gain over a year. Some dietary suggestions would be to eat less fast foods, less fried foods, more fruits and vegetables, 1% low-fat milk or calcium supplements, and regular exercise. Laboratory assessment may include a CBC, cholesterol, fasting triglycerides and lipoproteins.