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Lifestyle Management of Adult Obesity

Patient Presents

In June of 2000, Mrs. Jones, a 49-year-old post-menopausal, Caucasian woman presented to her primary care physician (PCP) reporting a new history (5–6 weeks) of fatigue, weakness, hyperphagia, excessive urination, dyspnea on exertion, lethargy, depression, and excessive thirst. She is a non-tobacco user with no known history of DM, hypertension, asthma, pulmonary disease, or cardiovascular disease (CVD). There is also no history of rheumatoid disorders, fibromyalgia, or osteoporosis.

Mrs. Jones has had arthroscopy of the left knee due to persistent pain, particularly on climbing stairs that revealed evidence of mild arthritis but no ligament or meniscus tears.

Current medications include Premarin®, 0.625 mg/day and Claritin® for allergies. She takes a multivitamin each day and has used over the counter weight loss supplements including herbal phen/fen (Ma Huang or ephedra) as well as St. John's Wort. She also has taken Echinacea, Astragalus, and Glutamine.

Pertinent information

C/o fatigue, weakness, excessive urination, dyspnea on exertion; no history of exercise or activity; knee pain.

Consider

Potential problems with weight bearing exercise due to history of knee discomfort; fasting plasma glucose for DM, lipid profile, thyroid, insulin levels; caution regarding use of herbal supplements, especially Ma Huang as it relates to sympathetic stimulation and potential health risks.