Mr Robertson is a 65-year-old retiree who lives with his wife. While he was in the workforce, Mr Robertson’s job as a construction overseer kept him active for several hours a day. Since retiring six months ago, he has adopted a sedentary lifestyle.

Mr Robertson sees his family doctor for a general medical examination. He believes he is in good health, and wishes to remain so in his retirement years. He gave up smoking 20 years ago. His father died from a myocardial infarction at age 55, while his mother and older brother were both diagnosed with type 2 diabetes in their sixties; so he has concerns about the possible significance of his family history. 

 

The doctor undertakes a physical examination that includes blood pressure, weight and height. Blood pressure measures 129/81 mmHg; weight is 198 lb (90 kg): both are higher than previous recordings. The doctor thinks that, if there is any further increase in blood pressure, anti-hypertensive medication will be called for; but as the first point of intervention he recommends that Mr Robertson see a dietitian about losing some weight.

Mr Robertson schedules a consultation. This is his first visit to a dietitian. When Mr Robertson arrives for his appointment, you ask him to complete a Nutrition Assessment Questionnaire.


 Access Mr Robertson's Completed Nutrition Assessment Questionnaire 

 

You review and clarify his diet history and take the following anthropometric measurements: height 5 ft 9 in (175 cm) and weight 198 lb (90 kg). The patient reports his weight six months ago as 172 lb (78 kg). You measure his waist-hip ratio as 1.0 and calculate BMI at 29 kg/m2. 

Mr Robertson tells you how much he is enjoying his retirement. He loves spending more time with family and friends. However, he has been gaining weight. His weight was never a problem during his working life. He didn’t “diet” or have to think about what he ate. But the weight gain since retirement is bothering him. His old clothes are tight, and he needs increasingly larger sizes. He is considering modifying his eating habits but does not know where to start. He and his wife, Desiree, go grocery shopping every Friday. She does the cooking, and he describes his diet as “good basic meals.” 

You discuss recreational activities and physical activity level. Most days, Mr Robertson does chores around his small garden, and he maintains a busy social life. Every Monday, he goes bowling, and afterwards has a cup of tea and fruit cake with friends. He bowls for a total of 60 minutes weekly. He walks slowly for 30 minutes per week and gardens daily for 15 minutes. Apart from this, he does not participate in any other physical activity. 

On Wednesdays, Mr Robertson goes to the cinema with his film club. He has a chocolate-coated ice cream. During the Friday grocery-shopping trip, the couple likes to buy a cake or donuts for when they get home. On Friday and Saturday nights, Mr Robertson watches the football on television and snacks on potato chips (crisps). He loves treating the grandchildren with chocolates on Sundays, and he enjoys two fun-size chocolate bars then.