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 of 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)