Eliana Witchell RD - Evidence-Based Nutrition
Case Study

Whole-Person Metabolic Recovery: Mind, Body, and Sleep

"I'm exhausted all the time. I'm depressed. I can't seem to lose weight no matter what I try. I feel like I'm failing at everything."

— Male, mid-40s, with obesity class 2, depression, obstructive sleep apnea, GERD

Key Clinical Outcomes

Weight Loss
47 lbs
Sleep apnea resolved
Energy Level
3 → 8/10
Patient-reported
CPAP Status
Free
No longer needed

Clinical Presentation

46-year-old male presenting with complex interconnected health challenges: obesity class 2 (BMI 37.8, weight 268 lbs, 5'10"), major depressive disorder (on sertraline 100mg), obstructive sleep apnea (CPAP dependent), GERD (on PPI), profound fatigue, and history of multiple failed diet attempts. Patient expressing feelings of hopelessness about health trajectory. Referred by psychiatrist who recognized metabolic component to depression management.

Medical History & Baseline

  • Obesity class 2 (BMI 37.8, weight 268 lbs)
  • Major depressive disorder (5 years, on sertraline 100mg daily)
  • Obstructive sleep apnea (diagnosed 2 years ago, CPAP compliant but resents device)
  • GERD (on omeprazole 20mg daily)
  • Chronic fatigue (energy level 3/10 most days)
  • Sedentary lifestyle, desk job with long commute
  • Previous diet attempts: calorie counting, keto (unsustainable), intermittent fasting (worsened mood)
  • High carbohydrate diet with frequent snacking

Nutrition Therapy Intervention

Whole-person metabolic nutrition therapy addressing the interconnected nature of obesity, sleep, mood, and metabolic health. Close coordination with psychiatrist to monitor mood during dietary changes. Emphasis on sustainable approach given history of diet failure and fragile mental health.

Nutrition Protocol

  • Therapeutic carbohydrate moderation: <150g/day (gradual reduction to avoid mood destabilization)
  • Protein prioritization: 140-160g/day for satiety and mood stability
  • Blood sugar stabilization: 3 structured meals, elimination of snacking
  • Sleep hygiene integration: no eating within 3 hours of bed (GERD management)
  • Omega-3 supplementation: 2g EPA+DHA daily for mood support
  • Vitamin D optimization: 4000 IU daily (baseline severely deficient)
  • Movement prescription: 20-minute post-meal walks (starting gentle)
  • No aggressive calorie restriction given depression history

Care Coordination

Weekly check-ins first month, close communication with psychiatrist regarding mood monitoring. Sleep medicine follow-up at 3 and 6 months for CPAP titration/discontinuation assessment.

Clinical Results Timeline

Month 1

  • Weight: 268 → 258 lbs (10 lbs)
  • Energy: 3/10 → 5/10 (noticeable improvement)
  • Sleep quality beginning to improve
  • GERD symptoms reduced (able to reduce PPI to every other day)
  • Mood stable (no worsening of depression)
  • Walking 15-20 minutes most days

Month 3

  • Weight: 243 lbs (25 lbs total loss)
  • Energy: 6/10 (substantial improvement)
  • Sleep study repeated: Sleep apnea improved (AHI 32 → 18)
  • CPAP pressure reduced, better tolerance
  • Mood significantly improved, psychiatrist noting positive changes
  • GERD resolved, PPI discontinued
  • Walking 30 minutes daily, started light strength training

Month 6

  • Weight: 221 lbs (47 lbs total loss), BMI 31.7
  • Energy: 8/10 (patient describes as "haven't felt this good in 15 years")
  • Sleep study repeated: OSA resolved (AHI 4, normal range)
  • CPAP discontinued per sleep medicine
  • Depression symptoms markedly improved
  • Psychiatrist initiating gradual sertraline taper (patient request, MD supervised)
  • Exercise routine established: walking daily + strength training 3x/week
  • Patient reports "finally feeling like myself again"

Clinical Discussion

Key Learning Points

  1. Metabolic health profoundly impacts mental health: Addressing metabolic dysfunction improved depression symptoms as much as medication adjustment.
  2. Sleep apnea resolution transforms quality of life: Eliminating CPAP dependency was highly motivating for patient continuation.
  3. Gradual, sustainable approach crucial for depression: Aggressive calorie restriction could have worsened mood; moderate carb reduction was well-tolerated.
  4. Multiple conditions improved simultaneously: GERD, sleep apnea, obesity, and depression all responded to same metabolic intervention.
  5. Multidisciplinary care enhances safety and outcomes: Close psychiatrist coordination enabled safe dietary changes and medication adjustments.

Struggling with Multiple Health Challenges?

Comprehensive nutrition therapy can address interconnected metabolic, sleep, and mental health challenges. Learn how a whole-person approach could support your recovery.

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Important Disclaimer: This program is for educational purposes only and does not replace individualized Medical Nutrition Therapy or medical care.

Personalized nutrition therapy services are available only in jurisdictions where Eliana Witchell, RD, CDE holds active licensure. Always consult with your healthcare provider before making changes to your diet, exercise, or medication regimen.