Case Presentation Date: March 5 Presenter : Carly Werner Main - - PDF document

Case Presentation Date: March 5

Presenter: Carly Werner

Main Question About the Case

What to do when non-surgical bariatric program doesn’t work? (How to support someone who has gone through program and regained all weight back?)

Demographic Information

• 65yo female
• Works f/t office job and p/t building maintenance
• Lives alone

Medical History/Status

• Did non-surgical bariatric program (OptiFast) in 2016; has regained all weight
• Very concerned about her weight and feeling so discouraged
• Has done many diets in the past including juicing and keto in recent past
• Curious about medication for weight loss – was given sample of Contrave but worries about

risk of seizures with eating high-fat foods

• Also met with me re: hx IBS – this makes her hesitant to try new medications
• Hx HbA1C 6.0% and FBS 6.1 but normal levels since 2016
• Knee injury and arthritis; planning to do some aqua exercises

Mental Health History/Status

• Very frustrated about repeated weight loss and gains through diets

Social History/Status

• Good connection with daughter – they do exercise together
• Son getting married end of May – wants to lose 20lbs before this

Nutritional History/Status

• Wonders if she is addicted to sugar
• Feels her appetite is stable through the day but feels quite hungry at night
• Drinks Bulletproof “Keto” coffee in morning – loves how stable it makes her feel
• I suggested more consistent intake of protein for satiety and probiotic as first step

for IBS

Recommendations

Medical & Surgical

• Saxenda/Ozempic injection instead of contrave-may help with HbA1C
• Check the med list: do any of those causing weight gain:
• Recommend work with pharmacist to investigate meds
• Investigate the lipid profile considering the hx weight cycling and the “keto coffee”
• Keto coffee and IBS: any noticed triggers?

Nutrition & Lifestyle

• Identify main barriers to her having success
• Change the focus from weight to health goals/encourage weight stability vs. setting a weight

loss goal

• Does she have true addictions to sugar?
• Ask if pt attend post med program support groups? If not, what are the barriers?
• Ask what the pt’s long-term plan is ( i.e. what happens after losing 20 lbs? Another weight

cycling? What are the risks?)

• Keeping the house environment clean-Grocery list to help with keeping the trigger foods out
• f the house: Click and Collect on-line grocery

Psychiatric & Psychological

• How realistic do you think the patient is?
• Identify what thought process is?
• Food and mood journaling
• Mindful eating/type of hunger
• Satisfaction journal tool: rating scale 1-10-low quality foods and relationship with

satisfaction? (check-in before and while eating)-intuitive eating approach

• Craving change workshop-group or one-one
• Relationship with stress level and weight regain
• Connection between divorce and weight regain

Social (Including support network, finances, employment, and housing)