I would recommend a lot of changes for this patient, including exercise, change of diet, and cessation of his smoking habit, to name a few. This patient should use a lumbar support pillow in his chair at work, as well as a foot support, to alleviate strain on his lower back form sitting all day. I would recommend that he quit smoking and change his diet to one containing less fatty foods, and much less cholesterol. The pain he feels in his neck could be partially attributed to high cholesterol. A baseline cholesterol reading should be taken and a diet recommended according to how high the level is, and how quickly it should be reduced.
The cholesterol reading can be taken at the same time he is administered a full physical. The patient should then be instructed to have a full physical done yearly, or at least every other year, since problems can and will develop faster the more he ages. Cessation of smoking will also help to lower the patients LDL reading. A reduced calorie and reduced fat diet should help to burn off some of the extra pounds that the patient is carrying around. It might also be recommended that he cut out the nightly beer in order to reduce those added empty calories from his diet as well. Drinking does not have to be completely cut out of his diet, however, since there have been studies showing drinking in moderation can be good for your health.
He should change the beer to wine, which typically tends to be healthier, and people are more apt to sip wine, as they are to guzzle beer, so less will probably be drank with that subtle change. The whiskey should probably be cut out all together, and the total reduction in alcohol consumption will help to reduce alcohol related heart and liver trouble, as well as calorie intake. It may be suggested that the patient not necessarily cut out the TV watching, but rather tow an exercise machine of some sort in front of the TV and fulfill his exercise quota in the time that he would normally be idle on the couch. This would make good use of his idle time, also cutting out the possibility of the patient using lack of time to exercise for an excuse. If the patients cholesterol was found to be high in the baseline draw of blood. It would be wise to take a LDL level every month, until the level begins to fall and then every several months until it is within normal range.
It would then be advisable to take a LDL level with each physical. Further suggestions for change of lifestyle, and/or diet should be made if the LDL level is not falling at the rate you expect, or not falling at all.