Case History/Examination
A 38-year-old female does not know to have any medical illness presented to obesity clinic at primary care for weight management. She was brought by her sister and aunt to the clinic because she was partially willing to lose weight. She did not undergo a structured weight-loss trial before. Her vital signs were height 146 cm, weight 193 kg, body mass index (BMI) 90.5 kg/ m2 with central obesity. Her blood pressure was normal with a regular pulse. All her laboratory work, other than high normal blood sugar, was normal. Therefore, metformin started. In addition, she had obstructive sleep apnea and c-pap started.
A multidisciplinary team was formed to discuss the case including preventive medicine, family medicine, diabetologist, endocrinologist, bariatric surgeon, and health coach. Both preventive and family medicine physicians had lifestyle medicine training along with the health coach. We suggested starting a structured lifestyle style intervention for six months then adding weight loss medications ‘’Liraglutide” then going for surgery.