History: Jose Garcia is a 68 y/o male with PMH of HTN, high cholesterol, arthritis in both knees and (questionable) pre-DM. He has been retired as a taxi driver for about 3 years. Jose smokes half a pack per day.

Additional info: BP 148/88 on BP meds, fasting glucose 120, weight 250 lbs, height 5’6’’ and waist circumference 45 inches.

Goals: lose weight and avoid DM

Current diet:

Breakfast: usually a buttered roll; eggs or pancakes on weekends

Lunch: sandwich or steak and fried plantains

Dinner: usually meat or fish with plantains or rice and beans

Dessert lover (pastries and flan)!

Fried pork skin lover!

Current exercise:

Jose is largely sedentary and has a lot of free time since retiring. His RR upon climbing up the stairs in office was 30. Jose enjoyed playing handball and riding a bike when he was younger.

Diet plan:

Jose mentions that he eats eggs for breakfast on the weekends when his wife makes them for him. Eggs are very easy to make, and I would recommend he eat more of them instead of a buttered roll, as eggs are high in healthy fats, vitamins and protein.

Jose’s diet involves a lot of plantains, which are starchy (lack nutrients and high in carbs and calories). For Jose, whose goal is to lose weight, he should replace plantains with vegetables that are high in vitamins and fiber, such as green peas and broccoli. Even sweet potatoes are a fine alternative, because they contain Vitamin C, fiber and potassium.

Jose should have his sandwich with whole wheat or whole grain bread, as they contain more fiber.

Jose should avoid fried food as much as possible because they aren’t good for cholesterol, heart health or weight, especially if trying to avoid diabetes. Air fryers are a great alternative! Chicken and fish are great protein options.

Jose should limit his dessert intake. Instead of pastries or flan, he should eat fruits of all colors, as they provide both sugar and fiber (so he can still enjoy his sweet treat).

Exercise plan:

Since Jose has a lot of free time on his hands, he is already a step ahead in this exercise plan! As a start (and because of his arthritis), Jose should walk about 10-15 minutes a day, and gradually increase the time when he starts to feel more comfortable. He should start bicycling again at a rate of 5-9 MPH. He should also begin playing handball again, even if he just hits the ball a few times at a slow rate. Eventually, Jose should incorporate a total of 30 minutes of exercise per day. Increased activity has been shown to help with diabetes, therefore it is crucial for Jose to start being active, especially if his goal is to avoid diabetes.

References:

https://health.clevelandclinic.org/top-10-worst-diet-choices-if-you-have-diabetes

https://www.hopkinsmedicine.org/health/wellness-and-prevention/prediabetes-diet