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LEARNING OBJECTIVES

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

  • 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.

PATIENT PRESENTATION

Chief Complaint

“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.”

HPI

Francine Martinez is a 35-year-old Hispanic woman who emigrated to the United States from Guatemala as a child. She has “yo-yo’d” with her weight since her teen years. She says 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 lose weight, mostly through trying to eat vegan like her roommate and going to 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 10 kg in the first 6 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 over the course of the busy toddler years and then even more during the stress of the divorce and hectic new lifestyle as a single working mom. She now lives in an apartment with her 5-year-old and says she struggles a bit financially because her ex-husband often does not pay the alimony or child support on time, but she’s thankful she has good medical insurance and prescription benefits through her employer. She says she has tried weight loss shakes but ...

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