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LEARNING OBJECTIVES

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After completing this case study, the reader should be able to:

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  • Identify common obesity-related comorbidities.

  • Calculate body mass index (BMI), and use waist circumference to determine a patient’s risk of obesity-related morbidity.

  • Develop a pharmacotherapeutic plan and treatment strategy for obese patients.

  • Provide patient counseling on the expected benefits, possible adverse effects, and drug interactions with weight loss medications.

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PATIENT PRESENTATION

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Chief Complaint

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“I’ve been through a painful divorce. I think I’m ready to try and get out and meet someone and start over, but I must’ve eaten my way through all of the stress of the separation and legal proceedings. Who’s gonna even look at me when I’m this size? I may have to take up smoking again. It was easier to stay skinny when I smoked.”

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HPI

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Francine Mallory is a 35-year-old woman who has “yo-yo’d” with her weight over the years. She feels best at 55 kg, which was how much she weighed when she was 23 years old and got married. She states that she was a “chubby” kid who really worked in college to “get healthier” through exercise classes at the college gym. That was also when she started smoking. She and her ex-husband were smokers and stopped when she was 27 because they wanted a smoke-free home before starting a family. She remembers frustration that while she “did great going cold turkey with the cigs,” she put on 12 kg in the first six smoke-free months. She “worked out like crazy” and dropped 7 kg before they conceived their first child at the age of 29. She delivered a healthy baby, although her pregnancy was complicated by a diagnosis of gestational diabetes and excessive weight gain (27 kg). Her hyperglycemia resolved postdelivery and she “was happy with how quickly most of the baby weight came off while nursing” but then she plateaued 8 kg above her prepregnancy weight and “just couldn’t get the rest off. I don’t have time to commit to exercising while juggling a job and family.” She has now put on more weight during the stress and hectic lifestyle of the divorce. She now lives in an apartment with her 5-year-old. She says she has tried weight loss shakes but finds herself just starving and “pigging out” at the end of the day. She says she does not have time for a gym membership or money for a “fancy program” where they provide meals for you. She has bought some “herbal stuff” from a coworker that helped with end-of-day hunger, but thinks cigarettes would be even cheaper than that. To economize and work with her hectic single-mom schedule, they eat out quite a bit based on where the “kids eat free” meal nights are (ie, an all-you-can-eat buffet on Monday nights and a pancake house on Wednesday nights, drive-thru meals at least ...

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