MKSAP: 47-year-old man with hypertension, type 2 diabetes mellitus, and obstructive sleep apnea

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 47-year-old man is evaluated during a follow-up examination. He is obese and has hypertension, type 2 diabetes mellitus, and obstructive sleep apnea. He reports that he has always has been overweight, and over the years, his weight has gradually increased to 123 kg (271 lb). During the past 2 years, he has tried several commercial diets; a dietician-monitored, calorie-restricted diet; increased physical activity; orlistat; and a combination of these interventions, all without achieving sustained weight loss. Medical history is also significant for bilateral knee pain and depression. He uses continuous positive airway pressure for his obstructive sleep apnea, and his medications are lisinopril, amlodipine, metformin, paroxetine, and as-needed ibuprofen. On physical examination, the patient is afebrile, blood pressure is 144/78 mm Hg, pulse rate is 86/min, and respiration rate is 18/min. BMI is 36. Cardiovascular and pulmonary examinations are normal. The abdomen is protuberant without pathologic striae. The knees show bony hypertrophy with crepitus, and there is trace bilateral lower extremity edema. Laboratory studies are significant for a HbA1c level of 9.1%. Which of the following is the most appropriate management to help this patient achieve sustained weight loss? A. Bariatric surgery B. Hypnosis C. Lorcaserin D. Very-low-calorie, physician-monitored diet MKS...
Source: Kevin, M.D. - Medical Weblog - Category: General Medicine Authors: Tags: Conditions Primary Care Source Type: blogs