Meal prepping and the time it takes. Stop eating during the night. Preparing lunch that she can eat at work....do they have microwave? Do they have somewhere to eat/ break room? Eating a healthy diet, getting time to go to gym, making it a part of her routine 3 to 4 times per week ...money for healthy eating a possibility. Address the changes slowly . .do not go on crash diets....drink a lot of water and increase fiber to feel full longer. Meditation Diet, DASH, ADA.

Introduce Easy meal planning. Small changes to add steps and activity into her day. Stress reduction and mindfulness to help with nighttime anxiety eating. Increasing water intake.

Potential barriers is busy lifestyle, eating out daily, sedentary lifestyle.

Meal prepping at least start packing lunch so she can make healthier choices. Breakfast can be meal prepped as well concentrating on protein rich quick meal suchvas hard boil eggs, healthy smoothie, etc.

She should stop soda at lunch and switch to water. Can add fruit to water for flavor.

She should start walking program. 20-30 minutes if able in the evening at least 5 days a week. Try to walk at lunch if just around the office, take the stairs.

Try to avoid eating after dinner unless water and small serving of fruit with protein. Consider healthy snacks during day as snack so she won't be so hungry at night.

It could be beneficial is the Dr attending Ms. M case can engage her in Motivational Speakers sessions as well as a Wraparound Case Management Service to try to made her to commit to a Treatment Plan and It might include a Nutritionist ( including a list of food she should avoid and the reason why) as well as ideas and combinations of a menu and, letting her know the late she might be eating before bed ( +- 2 h, suggesting her get a gym mate.

Acknowledge the fact that she wants to avoid medication but would approach her with a goal setting plan. Consult nutrition to help. If weight loss goal is not achieved within 3 months, then ask her to reconsider medication. I would emphasize her risk of progression to cirrhosis, as well as developing Diabetes, cardiovascular and renal disease as well.

I would assess renal function and cardiovascular risk as well. Nutritionist to assist with diet, also she could consider intermittent fasting, avoidance of high fructose corn sugar, refined carbs and reduction in sweets. Weight loss 10% has been shown to reduce inflammation and steatosis and reverse fibrosis as well as improve cardiovascular health. Low fat low cholesterol diet would be beneficial.

Check weight

BP

labs including hepatic panel, a1c, cmp, cbc and after 6 months

If weight loss has been achieved, I would repeat fibroscan.

Gym membership: could as someone to come with her (workout buddy). Try to work it into her schedule (perhaps 2 days a week), going after work or on the weekends.

Walking: increase walking at work during lunch, take the stairs, walk to co-workers office instead of calling or Teams them.

Walk with a buddy, after dinner. Break up walking into 10-15MINS intervals couple times a day.

Use a pedometer to count her steps

Breakfast: hard boil eggs, oatmeal, yogurt with fresh fruit and nuts, avocado toast with eggs, protein smoothie.

Night time snacks- nuts/seeds, celery and peanut butter, healthy trail mix, veggies with yogurt dip, banana and peanut butter, small fruit.

Drinks: water infused with fruit, unsweetened tea

Increase veggies with this being the largest on the plate

Try to avoid HFCS, limit sweets and refined carbs.

Weight loss at least 10%

Caloric reduction

at least 150min/week moderate exercise