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Original Question

Steve is a 39-year-old male who has been HIV positive for 6 years. His waistline is expanding, and he blames that for his recent onset of heartburn. Based on a physical examination and insulin resistance, his doctor diagnosed lipodystrophy syndrome. Steve is 6 ft tall and weighs 190 pounds. His weight has been stable for the last several years, although he feels “fatter.”He is on ART but is thinking of discontinuing the medication if it is the cause of his change in shape. He is willing to exercise but wants maximum benefit from minimum effort. He is also willing to change his eating habits but relies heavily on eating out. A typical day’s intake is shown on the right: • Evaluate Steve’s current weight. Would you recommend Weight loss? • How does Steve’s weight affect heartburn and insulin resistance? • How does his usual intake affect heartburn and insulin resistance? • What are Steve’s nutrition-related problems? What nutrition therapy recommendations would you make? • What would you tell Steve about exercise? • What criteria would you monitor to evaluate the effectiveness of nutrition therapy? Breakfast: A fast-food egg, bacon, and cheese sandwich on an English muffin; hash browns; large black coffee Lunch: Double hamburger; trench fries; cola Dinner: Grilled steak; baked potato with sour cream; water Snacks: Chips

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