Question

Mary Williams is a 78-year-old female who has stage 4 CKD, poorly controlled type 2 diabetes, and Class II obesity. She has was “chunky” as a child and adolescent with a life-time habit of having consumed a relatively high-fat, high-calorie diet. As she recalls, her entire family was overweight and she believed she had little control over the obesity.

After marriage she gained excess weight with each of her 3 pregnancies and was never able loose all the weight. Throughout her career, she worked as a legal assistant and spent most of her free time watching her children involved in various activities or watching television, and freely admits she has not really exercised since high school. Now, in her later years and following the recent death of her husband, Mary moved to a one-bedroom apartment within a long-term senior health care center.

Shortly after moving to her new residence, she experienced acute heart failure, which was subsequently resolved. She was also told her kidneys were “on the verge of failing”. The episode of acute heart failure and the realization that she could have renal failure frightened Mary, so she has become very engaged in her care and making an effort to follow medical recommendations. Since that time she has been advised to follow a Controlled Carbohydrate diet with a protein limit of 1 gram of protein/Kg and moderate intake of sodium, potassium, and phosphorus. She was also switched to a basal/bolus insulin regimen. She takes insulin at mealtime based on the percentage of meal intake corresponding to the insulin-to-carbohydrate ratio. For three months she has been successful at adhering to the treatment strategies, maintaining optimal blood glucose levels, meeting dietary goals, and maintaining a stable weight.

Mary has come to realize the adverse effects of chronic obesity and uncontrolled diabetes as reflected heart failure and chronic kidney disease. Her recent interested in following treatment recommendations is associated with the hope of avoiding further complications. Continuing to follow the treatment plan improves her overall health outlook. This case illustrates the complexity of this concept from the standpoint of the longstanding effects of overweight and obesity starting in childhood. Her family history, sedentary lifestyle, lifelong eating habits, and the subsequent complications are very typical for an individual with longstanding obesity.

Q #1 If you were to calculate Mary’s body mass index (BMI), what would it be? Explain how you arrived at your answer.

Answer 1

1.

Mary’s body mass index (BMI) will between 35 to 39.9.

Explanation -

Mary is having Class II obesity, obesity is divided into various classes. We consider it as obesity if BMI is above 29.9.

Again Obesity is divided into Class I if BMI is 30 to 34.9, Class II obesity if BMI is 35 to 39.9, Class III obesity If BMI 40 or above 40.