Answer to Question 1
A different approach to dieting should be used with each individual depending on their motivation. Since RB likes to eat because he likes good food, good substitutes to his high-fat, high-kcal dishes will have to be found. He also will have to be convinced that the high-fat foods are not good for him. This probably will be a difficult task. A good place to have a class discussion as to how this could be accomplished.
Answer to Question 2
It was calculated that 2583 kcals were required for RB to maintain his weight. Less 1000 kcals per day could produce 2 lb weight loss per week. Therefore, I would start with about 1300 kcals. This is a greater reduction than it seems since RB's requirement is 2583 kcals, but he is probably taking in a lot more than that. This amount of kcals will still allow RB a sensible diet without drastic restrictions but will certainly require modifications from his usual routine. It could be argued to start a little higher and gradually reduce to about 1200 kcals but I do not like this method and I believe it would be difficult to accomplish with this patient. Set a realistic goal for weight reduction, i.e., to lose 25 lbs in 5 months. After reaching that goal, set another one.
Try to reduce fat to no more than 20 of total kcals. Substitute low-fat items for the high-fat items. Try to eliminate sugar by using artificial sweeteners. Put emphasis on lean meats, more chicken, fish, and turkey. Take advantage of the foods he enjoys, such as veal, chicken, and fish. Use cheeses made from skim milk. Increase fiber, particularly soluble fibers; use skim milk or the low-fat creams that are available. Take advantage of the fact that he likes Italian seasoning and suggest various seasonings in place of salt.
Exercise according to the MD's recommendation. Reinforce that recommendation. Encourage joining a spa, or working out with a friend.
Eat more during the day and less at night. Try to eat earlier in the evening and do not go to bed right after eating. Use his cooking talents to create low-kcal Italian dishes that taste good.
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