Methods
Assessment of lifestyle ”Vital Signs”
All six pillars of lifestyle medicine were assessed. No physical activity or muscle strengthening exercise engagement during the week and most of the time spent sitting or reclining at home even. There were objective evidence major mobility limitations on a 400-m walk test and climbing one flight of stairs.
Regarding nutrition, on a typical day the patient was highly consuming sugary food/drinks and ultra-processed foods and minimal consumption of fruits and vegetables/day.
Sleep was for short periods interrupted and during the day. She usually gets four to five interrupted unrefreshed sleeping hours during the day. She was not a smoker or substance abuser and had limited social connections. Her mental health was reasonable.
Lifestyle interventions
The intervention aimed to create a negative energy balance through reduced calorie consumption by a plant-based diet avoiding processed food and increasing energy expenditure through gradual physical activity. Walking was added to the patient’s daily schedule starting with 2 minutes 3 times per day then progressing gradually. Sleep was increased up to 6 hours per night. Family support had a big role in patient weight loss success. The patient was hospitalized 5 days/ week at her sister’s home where she ensures compliance.