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A 33-Year-Old Woman With Morbid Obesity

Richard L. Atkinson, MD, Discussant
JAMA. 2000;283(24):3236-3243. doi:10.1001/jama.283.24.3236.
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DR AUDET: Ms C is a 33-year-old African American woman whose weight problems started in adolescence. Over the years, her weight has increased, despite attempts to lose or stabilize it. She currently works full-time and studies business administration. She previously studied culinary arts. Ms C has commercial health insurance.

Ms C is a well-educated woman who talks about her weight without difficulty. On initial assessment, her weight was 289.4 lb. Her height was 5'7'' and her body mass index (BMI), 45.4 kg/m2. Her highest weight as an adult was 296 lb and her lowest weight, 175 lb. Her obesity has contributed to additional health problems, including irregular menses in the past. Ms C has been diagnosed as having hypertension, which requires treatment with hydrochlorothiazide. On 1 occasion, her random glucose was elevated. Her exercise capacity is diminished, and she finds herself short of breath when walking and climbing stairs. In addition, Ms C has a history of deep vein thrombosis following prolonged immobilization during traveling. Ms C has a strong family history of obesity (her mother and siblings), hypertension, type 2 diabetes mellitus, and coronary artery disease. She does not smoke or abuse alcohol.

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