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INSTRUCTIONS FOR THE DOCTOR

This is a short case.

Please take a history, assess this patient appropriately and discuss a management plan with her.

Scenario

Taylor Jordan is a 30-year-old woman not previously seen by you. She has made an appointment to ask you for advice on losing weight.

Three months ago, she attended the surgery and was examined and tested to exclude any organic cause for her obesity.

The following information is on her summary sheet:

  • Past medical history

  • Irritable bowel syndrome

  • Medication

  • Ethinyloestradiol 30 mcg, levonorgestrel 150 mcg (Microgynon 30 ED)

  • Allergies

  • Nil

  • Cervical smear

  • None recorded

  • Immunisations

  • Recall due for Hep A and for Hep B second injection

  • Social history

  • Single

  • Non-smoker

  • Alcohol intake not recorded.

INSTRUCTIONS FOR THE PATIENT, TAYLOR JORDAN

You are 30 years old. You have always had a problem with your weight. You used to play hockey at state level but no longer exercise regularly. You work at a call centre about an hour’s drive from home. Life is a constant series of diets but your height is 1.70 m, your weight is 90 kg and BMI is 30.2 kg/m2 with an 80 cm waist. Three months ago, you attended the surgery and were examined and tested to exclude any organic cause for your obesity.

A friend at work lost weight through a very low-calorie diet but now she is putting the weight back on. You had thought of trying this diet but are now so uncertain about what to do that you have decided to see another GP for advice.

The following information is on your medical record:

  • Past medical history

  • Irritable bowel syndrome

  • Medication

  • Ethinyloestradiol 30 mcg, levonorgestrel 150 mcg (Microgynon 30 ED)

  • Allergies

  • Nil

  • Cervical smear

  • None recorded

  • Immunisations

  • Recall due for Hep A and Hep B second immunisation

  • Social history

  • Single

  • Non-smoker

  • Alcohol intake not recorded.

SUGGESTED APPROACH TO THE CASE

Establish rapport

Open questions to explore Taylor’s ideas, concerns and expectations.

Specific questions

Review current weight, BMI, waist circumference and trend1

Review current diet and alcohol intake

Review current exercise level and attitude towards exercise

Exclude eating disorder

Brief review of Taylor’s previous weight loss strategies.

Management2

Reassure that there is no need for further tests

Need for diet/activity balance and long-term sustainable change

Refer to reputable information sources regarding healthy eating, consider dietitian referral

  • — Five serves of vegetable and two serves of fruit per day

  • — Drink 500 mL water half an hour before food3

Advise about use and ...

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