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INTRODUCTION

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CASE LEARNING OBJECTIVES

  • Identify parameters utilized to diagnose obesity and other objective information that indicates the severity of disease

  • Identify desired therapeutic goals for patients who are obese

  • Recommend appropriate nonpharmacologic and pharmacologic therapeutic interventions for obese patients

  • Implement a monitoring plan that will assess both the efficacy and safety of therapy initiated

  • Educate the patient about the disease state and associated risks, appropriate lifestyle modifications, and drug therapy options necessary for effective treatment

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PATIENT PRESENTATION

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Chief Complaint

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"I will be 60 years old very soon. I am tired of being tired. I want more energy; I want to feel young again."

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History of Present Illness

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Joseph Michelson is a 59-year-old male patient presenting to the Cardiovascular Disease Risk Reduction Clinic for an initial evaluation. He was referred by his primary care provider for aggressive weight management. The patient states that he rarely eats healthy, even though his wife continually suggests healthier food choices. He prefers to eat meals high in fat and carbohydrates. He defines himself as a meat and potato type of guy. He snacks on corn and potato chips several times per day. He usually follows his salty snack with sweet-tasting foods, such as cookies or candy. He rarely consumes fruit. He drinks a glass of orange juice every morning. Throughout the day, he generally craves soda that is usually dark in color and caffeinated. Because of his work schedule, he finds it difficult to exercise. If he does have time to exercise in the evening, he lacks motivation. He has lost weight many times in the past. Each drop in weight resulted in him feeling more energetic and thus he appears ready to lose weight.

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Past Medical History

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HTN diagnosed 5 years ago

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GERD diagnosed 10 years ago

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Family History

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Father had CHD and died following a second MI at age 63. Mother is alive at age 89 with type 2 DM and hypothyroidism. He has 3 sisters and 1 brother who are all alive. His brother was recently hospitalized with cardiac chest pain (age 61).

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Social History

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The patient is married and lives with his wife of 41 years. He has 2 children (ages 35 and 39). He owns a small business that specializes in floor covering.

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Tobacco/Alcohol/Substance Use

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The patient denies tobacco use. He occasionally drinks alcohol, 1–2 beers on the weekend. No current or past illicit drug use.

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Allergies/Intolerances/Adverse Drug Events

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None

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Medications (Current)

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Metoprolol 25 mg PO twice daily

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Diltiazem 360 mg PO once daily

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Aspirin 325 mg PO once daily

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Ranitidine ...

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