42 year old female, 5’ 4”, 275 lbs, BMI 47.2 kg/m2. History of hypertension, chronic low back pain, severe gastroesophageal reflux disease, depression and type 2 diabetes (diagnosed 2 years ago), and anxiety/depression. Medications include lisinopril 10 mg daily, oxycodone 5 mg TID prn, omeprazole 20 mg daily, metformin 500 mg BID, and paroxetine 20 mg daily. She has been actively working with her PCP on losing weight with diet modification and water aerobics but has only lost about 4% of her weight in the past 6 months.
Current labs: (fasting) blood glucose 154 mg/dl, Hgb A1c 6.7 Creatinine 1.6, mg/dl and TSH of 3.6 U/ml.
What is the best course of action?
Apovian, C.M., Arrone, L.J. Bessesen, D.H. McDonnell, M.E., Murad, M.H., Pagotto, U., Ryan, D., and Still, C. (2015). Pharmacological management of obesity: An endocrine society clinical practice guideline. Journal of Clinical Endocrinology and Metabolism. 100(2): 342-362.doi: 10.1210/jc.2014-3415.
Mechanick, J., et al. (2013). Clinical practice guidelines for the perioperative, nutritional, metabolic, and nonsurgical support of the bariatric surgical patient - 2013 update. Surgery for Obesity and Related Diseases. 9(2013) 159-191. doi.org/10.1016/j.soard.2012.12.010
US Department of Health and Human Services. NIDDK. (2011). Bariatric surgery for severe obesity. Retrieved from
Dr. Melissa M. Davis,
DNP, ANP-BC, CNS, CBN, CNOR, RNFA
Nurse Practitioner / Program Coordinator
Center for Diabetes and Bariatric Surgery
Banner University Medical Center - Phoenix