Peter is a 24-year-old single man, living in low-income housing with his grandmother, working at a local chain drug store/pharmacy, who is coming to see Dr. Quinn for the first time for a checkup and refill of his asthma inhalers. Peter admits that he has not been to a doctor for “a few years.” He reports that he was treated for asthma as a child but felt he had “grown out of it”; recently, he began playing pickup games of basketball and had an asthma attack during a game last week, prompting this visit. Peter denies having any other medical issues and has no additional physical complaints. He takes no medicines. He reports occasional alcohol use, drinking “a six-pack” once a week, on average, when hanging out with friends; he denies daily use and denies that his drinking has a negative impact on his work or social functioning. He denies tobacco or cannabis use, acknowledging that when he has smoked in the past it has led to asthma symptoms. He denies any other substance use. He denies any mental health symptoms. Peter reports working five days a week at the drug store, the 4 pm–midnight shift, stocking shelves. When he leaves work, he tends to go to the local fast food restaurant where he picks up a meal. His lunch is usually also fast food. He will sometimes eat a roll with butter on his way to work, or he will skip this first meal of the day. He has not been getting regular exercise since high school, when he played on his school’s basketball team, but, as noted, he has recently started playing again. He denies any recent changes in weight and states that he has never been overweight. He says that he does not make enough money in his job to live on his own at this point and has chosen to stay with his grandmother, who has been living in her subsidized rental for 40 years. She is 62 years old and Peter worries about her, because she has been having more health problems; her son (Peter’s father) had been her main support, but he has recently been unable to care for her as he had a stroke at age 43. Peter has not had much contact with his father, but says that he is “heavy-set” and also may have “done some drugs”.

On exam, Peter is a trim young man, appearing well. His heart rate is 72, blood pressure is 132/70, height is 6′3″, and weight is 180 lb (BMI 22.5). His heart and lung exam is unremarkable. Dr. Quinn refers him for pulmonary function tests and suggests that they check his cholesterol and sugar levels. She also asks him if he would like to talk more about his diet, as she thinks that with a few changes in his nutrition (such as reduced sodium intake) his elevated systolic blood pressure might improve. She explains that he might be at increased risk for things such as diabetes, heart attack, and stroke in the future—acknowledging his grandmother’s and father’s health issues—and that he could help decrease his risk factors with some adjustments in what he eats and how he takes care of himself. Peter says he has in fact been wondering about this recently and would be interested in learning more.

No feeding and eating disorder diagnosis. Rule out alcohol use disorder.

Peter does not have an eating disorder. He has no identified preoccupations with food or his body, and his eating is not clearly causing any impairment in his general functioning. Nonetheless, Peter eats in ways that put him at risk for malnutrition and chronic disease.