A 42-year-old man with a history of type 2 diabetes (T2D), hypertension, and dyslipidemia presents to his primary care physician (PCP) for routine follow-up. He is concerned about a 30-lb weight gain in the past 4 months. His BMI is 28.5 and his A1c is 7.2%. He reports maintaining a healthy, low-calorie diet as part of self-directed behavior modification, which includes food tracking, meal planning, and cooking most meals at home. However, his physical activity is reduced. Six months earlier, he had completed an 18-month intensive behavioral weight loss program. His BMI was 24 and A1c was 6.5%.
Two years earlier, he presented to his PCP with various symptoms including lethargy, body aches, dyspnea on exertion, and regular bouts of heartburn and angina. His weight at the time was 290 lb (BMI, 39). He was diagnosed with T2D (A1c, 8.5%), hypertension (blood pressure, 170/95 mm Hg), and dyslipidemia (total cholesterol, 275 mg/dL; HDL cholesterol, 30 mg/dL; LDL cholesterol, 245 mg/dL; triglycerides, 198 mmol/L) He reported having an unhealthy lifestyle, lacking physical activity, and maintaining a high-calorie diet consisting of ultra-processed foods. He was started on metformin, benazepril-amlodipine, and atorvastatin.
To treat his obesity, his PCP recommended a behavioral intervention and referred him to a professionally directed program, where he met with a registered dietitian nutritionist (RDN). He was started on a low-calorie diet and a regular physical activity regimen, and, over the course of 18 months, met regularly with the RDN. He responded very well, losing 110 lb and reaching a BMI of 24. His obesity complications resolved or improved with weight loss. His blood pressure normalized, and he was taken off his antihypertensive medication. His A1c reached 6.5%, but he remained on metformin. His lipid profile was also normal (total cholesterol, 180 mg/dL; HDL cholesterol, 60 mg/dL; LDL cholesterol, 120 mg/dL; triglycerides, 120 mg/dL), and he was on a reduced dose of atorvastatin.