CASE STUDY 1

Patient S is a non-Hispanic white man, 33 years of age, who presents for an annual physical examination. He has no major complaints, but he does report some intermittent right knee pain. Patient S reports that his wife has expressed concern over his weight gain during the past two years. He thinks it is probably "around 10 pounds." He comments that he tries to watch his diet but does not do a good job. He is often in a rush and typically uses fast food restaurants as his source of meals. Patient S also reports that he does not engage in any structured exercise program. He remarks that it is just "too boring" and he does not have any time to go to the gym; however, he does have a membership at the local health club. Patient S is not currently on any medications, and there is no history of heart disease, hypertension, or cancer.

Patient S's height is 6'1", and his current weight is 240 pounds, with a calculated BMI of 31.7. His blood pressure is 135/85 mm Hg, and his heart rate is 84 beats per minute (bpm). A review of his medical chart from last year shows a 22-pound weight gain. The physical exam is largely unremarkable. There is full range of motion and normal strength of his knees, with no anterior/posterior drawer sign or fluid collection. His lab work is as follows:

Discussion with Patient S reveals that he is in the contemplation stage. He is currently inactive but is thinking about becoming active. His reasons for not going to the gym, although he has a membership, should be explored. For example, Patient S says he does not have time and exercise is too boring. One should point out that he could simply start with 10 minutes of exercise two days per week, and then slowly build up to the recommended levels. He should realize that exercise does not have to take place at the gym. He should focus on activities that he might enjoy, such as swimming or brisk walking, and possibly partner with his wife or friends to make workouts more interesting.