Problem List The patient apparently has several health problems, including obesity, diabetes, erythematous rash, and pain in the knee. The symptoms and examination results of the latter are consistent with osteoarthritis. Nearly all of her problems are directly associated with obesity (it serves as the most prominent predictor of diabetes, creates an excessive load on joints, introduces the risk of fat cell formation in them, and has been associated with instances of rashes). Therefore, obesity must be prioritized as a problem, followed closely by diabetes, since the two can be addressed through similar interventions.
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Important Strategies The most important health promotion strategies at this point are dieting and physical exercise. While additional data is needed for clarification, it is likely that her alleged diet is inconsistent. Proper dietary habits can minimize most adverse effects of diabetes and prevent obesity progress, and physical exercise is proven as a successful intervention for weight loss as well as managing level II diabetes. Circle of Caring There are two ways in which Circle of Caring would benefit the patient. First, support from the community and family is important for lifestyle changes associated with obesity treatment. Second, the pain caused by osteoarthritis would complicate physical exercising and would require the assistance of a trainer or a person with previous experience. Both are attainable through the Circle of Caring. Healthy People 2020 The objectives associated with improvements in diabetes control (e.g., D-6 and D-7) are relevant in the patient’s case. Next, objectives aiming at improved understanding of the issue (e.g., D-14) are consistent with the planned interventions. Finally, the objectives associated with the decrease in adverse outcomes (e.g., D-4) and death rate (e.g., D-3) can be considered relevant. E&M Level The problems presented in the case can be collectively described as of moderate severity. Therefore, it is reasonable to describe it as a Level 3 E&M visit, which would require the allowable reimbursement of $108.85. Follow-Up and Education It is important to explain to the patient the benefit of taking a proactive role in addressing the identified issues. The desired activities would include regular visits to the healthcare facility and testing for the health state. Education would include the advantages of lifestyle alteration and need to be approached from a collaborative and mutually beneficial standpoint to facilitate involvement. Complementary Therapies It should be acknowledged that there is currently no reliable evidence in support of improvements associated with CAM for the treatment of obesity. Nevertheless, depending on the social and cultural background, the incorporation of relaxation practices, yoga exercises, and mindfulness techniques may improve the efficacy of lifestyle-related interventions (Sperry et al., 2014).
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Morbidity and Mortality Rates According to the available data, there is a positive relationship between voluntary weight loss and the reduction in morbidity and mortality among adults. The recent meta-analysis of randomized controlled trials identified 15 reliable sources evaluating the effects of intentional weight loss (Kritchevsky et al., 2015). The results suggested at least a 15% reduction in all-cause mortality (Kritchevsky et al., 2015). Long-Term Commitment The consensus holds that the social and cultural environment is largely responsible both for the behaviors associated with obesity and the success of alternating them in order to achieve the desired effect (Sperry et al., 2014). Therefore, it would be reasonable to contact the patient’s husband to increase the likelihood of long-term commitment. Community-Based Approaches First, the community should be surveyed for the possibility of regular exercise, including the presence of dedicated facilities and environments, such as parks. Second, the community might offer classes and clubs focused on healthy eating and dietary education. Both can be referred to the patient for stronger support and peer assistance. References Kritchevsky, S. B., Beavers, K. M., Miller, M. E., Shea, M. K., Houston, D. K., Kitzman, D. W., & Nicklas, B. J. (2015). Intentional weight loss and all-cause mortality: A meta-analysis of randomized clinical trials. PLoS One, 10(3), 1-12. Sperry, S., Knox, B., Edwards, D., Friedman, A., Rodriguez, M., Kaly, P.,… Shaffer-Hudkins, E. (2014). Cultivating Healthy Eating, Exercise, and Relaxation (CHEER): A case study of a family-centered and mindfulness-based cognitive-behavioral intervention for obese adolescents at risk for diabetes and cardiovascular disease. Clinical Case Studies, 13(3), 218-230.