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Modifying Obesity Treatment

CE / CME

Primary Care Strategies for Modifying Obesity Treatment Based on Weight Loss Goals, Comorbidities, and Adverse Event Management

Physician Assistants/Physician Associates: 0.50 AAPA Category 1 CME credit

Nurse Practitioners/Nurses: 0.50 Nursing contact hour

Physicians: maximum of 0.50 AMA PRA Category 1 Credit™

Released: February 21, 2025

Expiration: February 20, 2026

Jaime Almandoz
Jaime Almandoz, MD, MBA, MRCPI, FTOS, DABOM
Angela Golden
Angela Golden, DNP, FNP-C, FAANP, FOMA
CME/CE Information

Activity

Progress
1
Course Completed

Case History and Presentation
A 40-year-old woman visits her primary care provider for her annual wellness examination, frustrated by ongoing weight gain since the birth of her second child 2 years ago. Despite following a low-fat diet for the past 8 weeks, she has not lost weight and seeks guidance. She states she is not interested in surgical intervention at this time.

Her past medical history includes hypertension, dyslipidemia, depression, gastroesophageal reflux disease, and obesity. She is divorced, lives with her 2 children, and shares custody with her ex-husband. She works from home for a digital advertising company. She reports feeling excessively sleepy during the day, experiencing early morning headaches, and struggling with fatigue.

Her current medications include losartan 50 mg/day, gemfibrozil 600 mg twice daily, a fish oil supplement, paroxetine 20 mg/day, and over-the-counter omeprazole 20 mg/day. She previously tried over-the-counter orlistat 60 mg three times daily but discontinued it because of gastrointestinal adverse effects.

On physical examination, her blood pressure is 146/92 mm Hg, weight is 198 lb, BMI is 34 kg/m², and waist circumference is 42 inches. Cardiopulmonary examination is normal, and there is trace bilateral edema.

Laboratory results include glucose of 92 mg/dL, A1C of 5.8%, total bilirubin of 0.6 mg/dL, albumin of 4.2 g/dL, alanine aminotransferase of 67 U/L, aspartate aminotransferase of 38 U/L, alkaline phosphatase of 140 U/L, total cholesterol of 240 mg/dL, low-density lipoprotein cholesterol of 146 mg/dL, high-density lipoprotein cholesterol of 40 mg/dL, and triglycerides of 270 mg/dL.

What is the most appropriate next step in this patient’s obesity management?