Obesity

Age: ‍ years old

Gender: ‍malefemale



HISTORY:

Presents with a ‍-‍year history of ‍inability to lose weightexcessive weight gain

Current weight: ‍ ‍kglbs

BMI: ‍

Attempts to lose weight so far: ‍none, ‍reduced fat, ‍reduced sugars, ‍reduced portions, ‍increased physical activity, ‍semaglutide, ‍bariatric surgery



Associated symptoms: *Try using right-click for negatives*

‍fatigue

‍shortness of breath on exertion, ‍IIIIIIIV/IV

‍orthopnea

‍lower extermity edema

‍excessive hunger

‍increased appetite

‍anxiety

‍depression



Contributing factors:

‍poor diet

‍sedentary lifestyle

‍stress

no history of: ‍diabetes, ‍hypertension, ‍dyslipidemia, ‍cardiovascular diseases, ‍sleep apnea, ‍osteoarthritis, ‍depression

no use of: ‍antipsychotics, ‍antidepressants, ‍insulin, ‍steroids, ‍beta-blockers, ‍new medication

no family history of: ‍obesity





EXAM:

General appearance: ‍well-appearing, ‍apparent distress

Vital signs: ‍normal, BP ‍, HR ‍, RR ‍, SpO2 ‍ %, Temp ‍°

Neck: ‍normal, ‍lymphadenopathy, ‍, c-spine ‍

Heart: ‍RRR, ‍MRG, ‍normal S1 and S2

Lungs: ‍clear bilaterally, ‍abnormal sounds, ‍retractions

Abdomen: ‍soft, ‍non-tender ‍, ‍non-distended, ‍

Extremities: ‍warm, ‍dry, cap refill ‍< 3> 3 sec, pulses ‍intact, ‍edema ‍bilaterally, ‍

Musculoskeletal: joints ‍ ‍normal, ‍limited ROM





ASSESSMENT:

‍Obesity ‍likelysuspectedpossible

DDx: excessive caloric intake, sedentary lifestyle, genetic predisposition, hypothyroidism, Cushing's syndrome, polycystic ovary syndrome, growth hormone deficiency, insulin resistance, medication side effect (e.g., corticosteroids, antidepressants, antipsychotics), sleep apnea, depression, eating disorders, leptin resistance, hypothalamic injury or disease, prader-willi syndrome, endocrine disorders, metabolic syndrome





PLAN:

Investigations:

- Blood work: ‍HbA1c, ‍fasting glucose, ‍lipid profil, ‍TSH, ‍cortisol

Treatments:

- Increase physical activity

- Dietary counseling

- ‍Weight loss medications

- Behavioral therapy

Further care:

- Referral to dietitian

- Referral to weight loss clinic

- Referral to endocrinologist

- Referral to bariatric surgery

- Follow-up in ‍ months