John Y is eighty years old and says that in his youth was an athletic young man playing several sport including competitive swimming, water polo and weight lifting. Later, he went on to study biomedical sciences and got involved in computer work. He describes his work life as a sedentary one;. When he was fifty-two years old he suffered a heart attack and had five coronary artery by-pass grafts done. John had had a demanding job that included lots of travelling in the UK and abroad and took early retirement. During that time he described himself as overweight but not obese; and not being particularly concerned about his weight. He tried to keep active by swimming and running and practicing scuba diving when on holidays. However, his work life had an effect on his diet. Travelling for work often meant eating on the go, snacking and eating lots of readymade planes meals. His consultant suggested to him to slow down which he subsequently did. Eight years after his first heart attack, he had a second one and doctors had to rebuild four of the original artery by-pass grafts. Then, and after eight more years, he had a third heart attack and he had three stents put in. Since then he has had no other coronary heart problems.

At one of his heart check-up appointments, he was sent by the consultant for tests to check his kidney function and he was later diagnosed with renal disease. He underwent a renal artery bypass graft to unblock his left kidney. This was successful and John explains that for the last fifteen years I;ve been stable on kidney functions;. However, ever since his renal surgery he has suffered with severe back problems. He describes, that this is because he has no stomach muscles function so his back muscles have to do all the work. He has seen two pain management consultants, a sports physiotherapist and has had acupuncture. His back pain is not constant but he has noticed that his flare-ups are getting worse. On a good day, he can walk about a kilometer but with stops in between. John wonders why this is happening to someone like him – a former athlete. He has tried several therapies: epidural injections, facet joint and steroids injections as well as acupuncture but none of them have improved his condition.

John feels that his health problems are affecting his ability to manage his weight. He says that according to BMI measurement his ideal weight should be ten and a half stone and he is currently pushing towards twelve stone. As a former athlete, he knows that exercise will improve his fitness levels which in turn, would help him lose weight.

One thing that John is able to influence is his diet, and has put several rules in place. For instance, he doesn’t overeat, doesn’t snack between meals, doesn’t drink alcohol or sugary drinks and drinks plenty of water. He and his wife are not following a particular diet plan but they are eating a healthy and well-balance diet. He says that they regulate their calories intake so if they have a celebratory meal one day, they eat less food the next.