Case 102: Obesity

PATIENT PRESENTATION

Chief Complaint

“I am tired and unmotivated to do anything besides watch television series and movies on Netflix from the comfort of my couch.”

History of Present Illness

A 51-year-old female patient reports to the pharmacist-managed Weight Loss Clinic for an initial evaluation. Patient states that she has tried numerous diets to lose weight, but none have allowed her to achieve weight loss.

Link to EMR

Student Work-Up

TARGETED QUESTIONS

1. How would you classify this patient’s BMI?

   Hint: See Table 102-1 in PPP

2. Does this patient have modifiable cardiovascular disease risk factors, and if so, which one(s)?

   Hint: See Treatment in PPP

3. Is this patient a candidate for weight loss, and if so, what is the initial weight loss goal?

   Hint: See Treatment (Key Concept #5) in PPP

4. Is nonpharmacologic therapy, pharmacologic therapy, or both recommended for this patient?

   Hint: See Treatment in PPP (or Table 102-3)

5. How often should the patient return for follow-up and what patient parameters need assessed?

   Hint: See Outcome Evaluation in PPP

FOLLOW-UP

The patient has returned for all scheduled follow-up assessment visits in the Obesity Management Clinic. At the 3-month follow-up visit, it was determined that the patient’s weight decreased by 7 pounds (3.2 kg). Her waist circumference is now 53 inches (135 cm). She is compliant with drug therapy previously recommended but has not committed to routine physical activity. Should the initial therapeutic recommendations be altered, and if so, how?

Hint: See Treatment in PPP

CASE SUMMARY

Global Perspective

Energy imbalance, or energy intake greater than energy expenditure, is a key factor in the development of obesity. The longer the imbalance occurs, the greater the extent of obesity. Height and weight can easily be assessed anytime a patient-provider interaction occurs. From these two parameters, BMI can be determined. Waist circumference should also be evaluated as well as presence of other comorbidities and cardiovascular disease risk factors. Weight reduction, maintaining weight loss, and preventing weight gain are the general therapeutic goals for obese patients. Controlling related risks is an additional goal in the management of obesity. Lifestyle changes (dietary modification, increased physical activity, and behavioral therapy), drug treatment, surgery, or a combination of strategies are necessary for meeting desired outcomes. Frequent follow-up is necessary to determine the success or failure of the treatment plan.

Key References