MKSAP: 49-year-old woman with obesity, hypertension, and type 2 diabetes mellitus

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.

A 49-year-old woman is evaluated during a follow-up visit. She is overweight and has hypertension and type 2 diabetes mellitus, both of which are well controlled. For several years, she has attempted to lose weight through various commercial diets; dietician-monitored, calorie-restricted diets; and physical activity. She has worked with a behavioral therapist, and although she has not achieved weight loss, her weight has remained stable. She exercises 30 minutes daily. Medical history is also remarkable for glaucoma, generalized anxiety disorder, and chronic constipation. Medications are lisinopril, metformin, timolol eye drops, and sertraline.

On physical examination, temperature is normal, blood pressure is 128/74 mm Hg, pulse rate is 70/min, and respiration rate is 12/min. BMI is 29. Waist circumference is 92 cm (36 in). Head, neck, lung, and heart examinations are normal. The abdomen is obese without striae.

In addition to continuing calorie restriction and exercise, which of the following is the most appropriate management to help this patient achieve weight loss?

A. Lorcaserin
B. Orlistat
C. Phentermine-topiramate
D. Roux-en-Y gastric bypass

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