Woman, 55 years of age, referred to me for obesity management. She visited without recent labs, so we got started with the agreement she would get her labs drawn soon after her visit. At our first visit, her blood pressure was 150/98, HR 64, and weight 204, BMI-35, therefore her BMI category was class II obesity. PMH-+Migraine Headaches. FH-+Mother died of lung cancer. Her mother was a smoker. Patient is not.
I first met with her in person, then planned weekly follow up by telehealth.
She reported having lost weight several times in her life, but would always slowly gain it back. She did not want to do this again. She wanted to lose weight and keep it off!
She reported that low carb was what seemed to have worked for her in the past, but she does like and wants to eat some sweets. Together, we designed a plan for her so she could lower her carbs and have “some sweets.” We would work out how to make that work for her.
We first agreed on the meal plan, that she would weigh twice a week, and that she would keep a food log. She did get her labs within days of our appointment. Abnormal-A1C was 5.8%. Prediabetes. After getting back her labs, she was started on metformin.
She also got her blood pressure rechecked several times. It was and remains in the 100-110/70-80 range. Her A1C 6 months after our first meeting was 5.5%.
It has been 14 months since we have met. She has lost 60 pounds. Her weight is now 144 pounds. She is taking metformin 1,000mg/twice daily. Topiramate-100mg/every evening for migraines prescribed by her pcp and oh, by the way, it can also cause weight loss.
- So many patients don’t want to keep a food log, but they can be very helpful not only in losing weight but also weight maintenance. Make sure it’s the type of “logging” the patient will do. Keep it simple!
- There’s more to obesity management than telling patients to eat less and move more. It’s as complex as each of our patients are individuals.
- Obesity management is a specialty that is finally being recognized as such.
Joy Pape, FNP-C, CDE
Medical Editor, Diabetes in Control
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