Rosemary, a 55-year-old female, has just had her annual physical examination with the nurse practitioner. She was shocked to learn that she has gained just under 13.6 kg (30 lb) since her office visit...

Rosemary, a 55-year-old female, has just had her annual physical examination with the nurse practitioner. She was shocked to learn that she has gained just under 13.6 kg (30 lb) since her office visit 2 years ago, 7.7 kg (17 lb) in the last year alone. She went through menopause 2 years ago and thought that some of the mild edema and resulting weight gain she used to experience around the time of her menses was over. Rosemary has always been under or at normal weight except for the last office visit. At the time she was going through a personally stressful time and was not concerned about the weight gain. She works in an office as a financial manager, spending most of her day at her desk. Although she tries to get out for a lunchtime walk, most days, there is just too much to do in the office. The rest of her physical was unremarkable except for a borderline hypertensive reading on her blood pressure of 138/82 mmHg. Her heigh is 1.6 meters (5 ft 6 in.), and she now weighs 79.5 kg (175 lb). She states that she “watches what she eats” and normally eats three meals per day: a hurried breakfast of “something from the local fast-food place” on the drive to work, a sandwich at her desk or “whatever the rest of the office is ordering for take-out” for lunch, and a “regular dinner” at home at night with her husband. On the evenings when her husband is not home for dinner, Rosemary picks up something at the local supermarket from the prepared food aisle. She also enjoys a glass of wine with dinner. When the nurse and Rosemary add up the approximate number of calories she consumes, the average total is over 2,000 per day. Rosemary is upset and asks the nurse about weight loss strategies.

1. Rosemary asks about diet pills because her mother used to take them on occasion. What would you tell her about the availability of these drugs today?

2. Rosemary would like to try orlistat (Alli), which she has noticed on the shelf in the supermarket. What does Rosemary need to know about orlistat before deciding to take it? What teaching does she need about taking orlistat?

3. What factors have contributed to Rosemary’s weight gain over the past 2 years? What general health teaching would be appropriate for Rosemary to aid her in her weight reduction?