THIS IS AN ONLINE E LOG BOOK TO DISCUSS OUR PATIENT'S DE-IDENTIFIED HEALTH DATA SHARED AFTER TAKING HIS SIGNED INFORMED CONSENT. HERE WE DISCUSS OUR PATIENT'S PROBLEMS THROUGH SERIES OF INPUTS FROM AVAILABLE GLOBAL ONLINE COMMUNITY EXPERTS WITH AN AIM TO SOLVE THOSE PATIENT'S CLINICAL PROBLEMS WITH COLLECTIVE CURRENT BEST EVIDENCE BASED INPUTS.
29M quantified self PaJR
PaJR = patient journey record where patient advocate share a patient's updates according to guidance they get from their primary care provider who is supported by a group of volunteer medical professionals (ranging from medical innovators who may be engineers and medical students, to residents and consultants. Basically a knowledge network). [Currently Implemented as a whatsapp group]
The patient advocate ensures privacy, data management, and continuity of care.
The updates are:
- lifestyle modification related eg. Calorie deficit
- medication adherence related,
- patient education queries, etc.
The current case is a 29 year old otherwise healthy but obese man having weight of 86.5-87 kg even after being physically active. His height is 5 feet 5 inches, BMI is 32 and below is picture from Google fit (mobile) data about his daily walk (since many months his average is 5km daily).
All the analytics and charting below is done with help of ChatGPT (free version) and google collab (to run python code output given by chat gpt).
Estimated Basal Metabolic Rate (BMR) for this 29-year-old obese man is approximately 1877.22 kcal/day.
For 1 month of calorie deficit (31 days) patient maintained average daily total walk of 5km. Checked weight nearly every week - 86.5, 85, 84, 83, 82.5.
These are his daily calorie intake for 31 days. (Calorie counting done manually by patient advocate. )
1. 600 kcal
2. 750 kcal
3. 1200 kcal
4. 1000 kcal
5. 1100 kcal
6. 800 kcal
7. 900 kcal
8. 1700 kcal
9. 1300 kcal
10. 1400 kcal
11. 2000 kcal
12. 1500 kcal
13. 1250 kcal
14. 1500 kcal
15. 1800 kcal
16. 1450 kcal
17. 1150 kcal
18. 1400 kcal
19. 1450 kcal
20. 1500 kcal
21. 1800 kcal
22. 1500 kcal
23. 1400 kcal
24. 1300 kcal
25. 1200 kcal
26. 1250 kcal
27. 1700 kcal
28. 1900 kcal
29. 1150 kcal
30. 1000 kcal
31. 1350 kcal
Patient used to take around 2500 kcal daily before starting intervention.
Here are some useful graphs. (The data is in reverse order in these graph 1, 2, & 4). 
ChatGPT - One fascinating insight from this reverse order calorie counting data is the oscillation between higher and lower calorie days. By visualizing this data as a sine wave graph, with each day represented as a point along the curve, we see a rhythmic pattern emerge. The peaks and troughs represent days of higher and lower calorie intake respectively, creating a visually stunning wave pattern that illustrates the natural ebb and flow of dietary habits. This visualization highlights the balance between indulgence and restraint, offering a captivating depiction of the intricate dance of calorie consumption over time.
In simple words
- trend is useful to see it started Aggressive and plateau at around 1500 kcal
- seasonal indicate that after getting more strict patient is going back to less strict by variation of around -200 to +200 kcal range.
This data also helps to predict calorie intake for next day it may have high inaccuracy. Regression analysis predicted next day calorie intake to be 1561 kcal.
Useful motivating / behavioural nudging messages are also possible which may also have good information to help reduce junk food intake by awareness. Like -
Day 1 - 600 calories intake: Equivalent to approximately 0.7 liters of petrol or 1.3 servings of chowmein.
Day 31 - Calorie deficit: 2500 - 1350 = 1150 calories
1) Equivalent to approximately 10,000 steps of brisk walking.
2) Equivalent to 45 minutes of high-intensity interval training (HIIT).
02-06-2024
29 m quantified self pajr -2
Energy expenditure
Weigh loss trend
.jpg)
Average energy expenditure daily by calculation (differs alot from values in Google fit)
BMR for 82kg weight, 29M = 1800
Calorie burnt in moderate speed walk is equal to weight of person for each km. So 80kcal per km.
Average daily walk - 7km
Average daily expenditure in walk = 560kcal
Average daily calorie expenditure = 2360kcal
Calorie intake data till 2 may from 7 April.
2 may - 1300 kcal
1 may - 1800 kcal
30 apr - 1600 kcal
29 apr - 1040 kcal
28 apr - 2300 kcal
27 apr - 950 kcal
26 apr - 1530 kcal
25 apr - 1280 kcal
24 apr - 1500 kcal
23 apr - 1400 kcal
22 apr - 2075 kcal
21 apr - 1200 kcal
20 -
19 apr - 1200 kcal
18 apr - 1150 kcal
17 apr - 1500 kcal
16 apr - 1400 kcal
15 apr - 1500 kcal
14 apr - 1425 kcal
13 apr - 1250 kcal
12 apr - 700 kcal
11 apr - 1450 kcal
10 apr - 1400 kcal
9 apr - 1200 kcal
8 apr - 1620 kcal
7 apr - 1600 kcal
Pics of a few meals
Example of calorie counting on a day
Breakfast
- litti (4) - 240 kcal
Lunch
- chhachh - 50 kcal
- tea with sugar - 50 kcal
Evening
- Lassi - 350 kcal
- mango Pana - 100 kcal
Night
- curd - 250 kcal
Total
- Calorie intake = 1040 kcal
- walk = 8 km
- calorie expense = 2520 kcal (google fit shows 2140 kcal)
- calorie deficit = 1480 kcal.
Height 5.5
Weight 80.5 from 87
BMI - 29.5 to 32
Abdominal girth - 102 from 112 cm
Waist circumference - 100 from 106 cm
MAMC 33 cm.
29m quantified self pajr - 3
[28/04, 7:43 pm] PPM 4: Check out concept of SDA(Specific Dynamic Action)
[28/04, 7:50 pm] PPM 3: Specific dynamic action (SDA), also known as the thermic effect of food (TEF), refers to the energy expenditure associated with the digestion, absorption, and metabolism of food. Essentially, it's the energy your body uses to process the food you eat. Different macronutrients have different SDA rates. For example, protein has a higher SDA compared to fats or carbohydrates. This means that your body burns more calories digesting and metabolizing protein compared to other nutrients.
[28/04, 7:50 pm] PPM 3: How clinician can use this info for this case?
[28/04, 8:02 pm] PPM 4: Basically..
BMR is the energy your body needs to function at rest. SDA(aka thermic effect/dietary induced thermogenesis) is extra energy your body burns to process food. It covers digestion, absorption and storage of nutrients from what you eat. Proteins have high SDA, requiring more energy to process compared to carbs and fats.
Sda is another layer over BMR in understanding total energy expenditure in body.
Total energy expenditure is BMR+SDA+Activity level
Basically we say, bmr is engine size of your metabolism and sda is fuel efficiency.
By understanding TEE, we can tailor/better understand weight gain/loss
[28/04, 8:03 pm] PPM 3: Useful
2) To calculate your Basal Metabolic Rate (BMR), we can use the Harris-Benedict equation.
For males:
BMR = 88.362 + (13.397 × weight in kg) + (4.799 × height in cm) - (5.677 × age in years)
First, we convert your height to centimeters:
5 feet 5 inches = 165.1 cm (1 foot = 30.48 cm, 1 inch = 2.54 cm)
Now, plug in the values:
BMR = 88.362 + (13.397 × 81.5) + (4.799 × 165.1) - (5.677 × 30)
BMR ≈ 88.362 + 1093.955 + 791.334 - 170.731
BMR ≈ 1803.92 calories per day
So, your Basal Metabolic Rate (BMR) is approximately 1803.92 calories per day. This is the number of calories your body needs to maintain basic physiological functions at rest.
3) [19/04, 7:06 am] PPM 3: Cgpt
The estimation of calories burned during activities like walking involves several scientific methods and studies. The calorie expenditure for an activity like walking is typically determined through experiments that measure energy output in controlled settings. Here’s a brief outline of how scientists might arrive at such data:
1. **Metabolic Measurements**: One common method to determine calories burned is through direct and indirect calorimetry. Direct calorimetry measures the amount of heat the body emits, but it’s complex and not widely used. Indirect calorimetry is more common and measures oxygen consumption and carbon dioxide production. Since the body needs oxygen to burn nutrients for energy, and produces carbon dioxide as a byproduct, measuring these gases can give a reliable estimate of energy expenditure.
2. **Using Metabolic Equivalents (METs)**: The concept of METs (Metabolic Equivalents) is often used. One MET is defined as the energy it takes to sit quietly, equivalent to a calorie expenditure of 1 kcal/kg/hour. Physical activities are assigned MET values based on how much harder your body works relative to sitting quietly. For example, walking at a mild pace (about 3-4 mph) typically has a MET value of around 3.0 to 4.5 METs.
3. **Calculations Based on METs**:
- First, the MET value is multiplied by the person’s body weight in kilograms.
- Then, this number is multiplied by the duration of the activity in hours to find the total caloric expenditure.
For instance, if walking at a mild pace has a MET value of 3.5, an 80 kg person walking for 1 km (which they might complete in about 10-15 minutes, or about 0.2 hours), the calculation would be:
\[
\text{Calories burned} = 3.5 \text{ METs} \times 80 \text{ kg} \times 0.2 \text{ hours} = 56 \text{ kcal}
\]
(Note: This is just an example; actual values might vary based on the specific speed and individual metabolism).
4. **Field Studies and Adjustments**: Scientists also conduct field studies where they monitor real-life activities rather than controlled laboratory settings. They might use portable devices that track physiological responses like heart rate, breathing rates, and even sweat rates to estimate energy expenditure more accurately in day-to-day activities.
5. **Calibration and Validation**: Any method used to calculate or estimate caloric expenditure is usually calibrated against more established methods (like those using laboratory equipment) and validated in different populations to ensure accuracy across age, body weight, and fitness levels.
When it comes to the provided data — an 80 kg person burning 80 calories walking 1 km — this might be a slightly simplified or rounded figure used for easy calculation. In actuality, the calories burned can be influenced by factors like walking speed, terrain, efficiency of movement, and individual metabolic differences. The figure could be derived from an average or estimated value that broadly fits the profile and activity described.
[19/04, 7:28 am] PPM 3: "Definition
A MET is defined as the resting metabolic rate, that is, the amount of oxygen consumed at rest, sitting quietly in a chair, approximately 3.5 ml 02/kg/min (1.2 kcallmin for a 70-kg person).* As such, work at 2 METS requires twice the resting metabolism or 7.0 ml O,/kg/min and three METS requires three times the resting metabolism (10.5 ml 02/kg/min), and so on"
[13-10-2025 20.07] PPM 3: Story of age 10 to 30
He never had difficulty to sleep sir. He believes that he had developed habit of staying awake and functioning with less sleep or food. Like one year he had average 3+ hours of sleep per day (age 22). Once he tested his capacity and stayed awake for 7 days with only 2 spoons of sugar and 10 parle g biscuits daily while coding software for working 18 hours a day (age 18). Usually he had 5+ hours of sleep but now he sleeps atleast 6+ hours average since 5 years and now he sleeps daily since 2 years as he had to recover his mental health so considered sleep as important factor. He also used to have sleep as coping mechanism from any stress in life. Slept alot like 10-20 hours according to stress.
He used to feel body pain when not slept for 3 days but after losing the training now he feels body pHe had capacity to sleep/nap anytime anywhere ignore all disturbance and that's because of keep self deprived. Now when he sleep well, disturbance breaks his sleep but he completes his hours.ain even if not sleeping 1 day.
7 days without sleep was an effort for trying to touch world record. He couldn't. Slept 12 hours straight after 7 days and ate food enough for 2 people at once after waking up, then all normal.
Body pain tiredness irritability were common problems he had and he could manage these easily due to getting habituated.
Sleep less <-> crash sleep. Eat less <-> eat alot.
His pattern for many years.
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