Health Promotion and Disease Prevention: Case Study for Damien Jackson
Brief overview on Damien Jackson:
Damien is 33 y/o African American male with hypertension and gout. He is overweight, smokes a cigar socially a few times a week, lives with his girlfriend and 4 y/o son in Brooklyn and just changed jobs from being a truck driver to a mail carrier. He hasn’t had regular healthcare for 15 year, but now wants to make changes in his life.
Vaccines:
Damien’s childhood vaccinations are up to date.
Influenza: I would give Damien the Influenza vaccine. I would explain to him the importance of getting the vaccine because he has a 4 year old child at home.
Tetanus-Diphtheria booster: Damien has not had regular healthcare for 15 years, he is overdue for the Td booster. (Typically given every 10 years)
Screenings:
Damien has hypertension, drinks alcohol only on occasion and smokes approximately 4 cigars a week. I would like to screen Damien for depression, obesity, and HIV infection.
Safety:
Discuss motor vehicle safety such as wearing a seatbelt.
Diet/weight loss:
Damien has a BMI of 28.7 and a waist circumference of 43 inches, which means he is overweight. Losing weight would improve Damien’s blood pressure and his gout. A reasonable weight loss goal for Damien would be 20 – 30 pounds in the first year. Being overweight and having a high waist circumference increases Damien’s risk for cardiovascular disease and type 2 diabetes mellitus. Having high blood pressure increases one’s risk for developing heart disease. As such the goal of Damien’s is to lower his blood pressure and risk for cardiovascular disease. The DASH diet (Dietary Approaches to Stop Hypertension) involves decreasing the consumption of red meat, sodium, and sweets. Gout develops from the crystallization of uric acid. When the body breaks down purines it creates produces uric acid. Red meat is high in purines. This diet would also help with his gout. Damien consumes a lot of meat, I would start by swapping out a few portions of red meat a week for other proteins, such as edamame. Edamame is an excellent choice, since it is a complete protein, is low in purines and a food Damien enjoys. Damien consumes a gallon of full fat milk a day. I would start by switching to low fat milk. Controlling his blood pressure can reduce the number of gout flare ups. It is important to lose the weight slowly. Losing the weight will help decrease the pain from the gout, but losing a lot of weight at once can actually cause a gout attack. Damien loves sweets, I would encourage Damien to swap a sweet a day for a fruit.
Possible meal options for Damien:
- Breakfast options:
- Whole grain cereal with low fat milk and a fruit
- 1 slice whole grain toast, 2 eggs with a salad
- Whole grain, low fat oat muffin with sliced fruit
- Lunch options:
- Salad with chicken breast
- Turkey vegetable wrap
- Turkey/chicken burger whole grain sandwich
- Dinner options:
- Chicken stir fry
- Grilled salmon and whole wheat rice and salad
- Bean soup with toast and guacamole
- Snack options:
- Low fat yogurt with granola
- Berries with granola
- Nut/date bars (Good option for when he is on the go.)
Exercise:
The CDC recommends 150 minutes of moderate-intensity exercise a week. As a mail carrier walking from house to house and up and down steps, Damien will easily get 150 minutes of exercise in a week. The CDC also recommends muscle-strengthening at least 2 times a week with all muscle groups. I would encourage Damien to add muscle strengthening to his weekly activity, but I would implement the strength exercise at a later time, after he adjust to his new job.
Tobacco Cessation:
On average Damien smokes four cigars a week when he wants to relax with friends. Cigars vary in size, a super-sized cigar can be equivalent to a pack of cigarettes. Since Damien smokes to relax I would encourage him to find other methods for ways to relax. I would encourage Damien to switch one cigar activity with his friends for something else. He enjoys the outdoors, his church community and basketball. Any such activity would be an option to substitute for hanging out with his friends in a cigar bar.
Brief Intervention for Obesity:
Ask: I would ask Damien if he wants to discuss his weight. “Damien would you be interested in discussing your weight?”
Assess: His BMI is 28.7 (which puts him in the overweight category), his waist circumference is 43 inches which is high. I would like to assess what his challenges are that caused him to gain weight, and what challenges make it hard for him to lose weight. “What factors do you think contributed to your weight gain?” “Where would you rate yourself on scale of 1 – 10 in terms of how ready you are to change?”
Advise: I would inform Damien of his current risk factors for type 2 diabetes mellitus, cardiovascular disease, and discuss its relevance to his high blood pressure and gout. I would also go over the benefits that weight loss will have on his health and life. We would discuss the benefits of making small changes at a time.
Agree: After going over the details of why change is important and how he can make changes we would agree on a plan.
Assist: I would inform Damien of the resources available to lose weight, such as support groups and dieticians. If Damien is interested, I would assist him in setting up an appointment for him. I would also make a follow up appointment with him to see where he is holding in a few weeks and to continue to discuss the plan.
Order of implementing interventions:
- Diet
- Smoking
- Screenings
- Vaccines
- Exercise
References:
https://www.nwkidney.org/wp-content/uploads/2014/07/Nutrition-Tips-Gout.pdf
https://www.cancer.gov/about-cancer/causes-prevention/risk/tobacco/cigars-fact-sheet
Modified 5 As: Minimal intervention for obesity counseling in primary care, Vallis et al., January 2013
