Internal Medicine 16 45-year-old male who is overweight
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Aquifer Case
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Internal Medicine 16-45-year-old Male who is Overweight
Obesity (E66. 9) is the most likely differential diagnosis for the 45-year-old Male with complaints of
increased weight. An excessive quantity of body fat is a complicated condition known as obesity. According to
Chooi and Ding (2019), it raises the risk of several illnesses and ailments, including high blood pressure,
diabetes, heart disease, and several types of cancer. Obesity occurs when there is more intake of calories than is
burned through normal daily activities and exercise. Its symptoms are diagnosed by calculating the Body Mass
Index (BNI). If the BMI is 30.0 kg/m2 or higher, the patient will be diagnosed with obesity. On physical
examination, it was found that the patient had an increased weight of 220 lbs, a waist circumference of 42
inches, LDL-141 mg/dl, total cholesterol of -206 mg/dl, and blood pressure is 122/64 mmHg. With these
symptoms and indications, the patient should be considered a suspect of obesity.
Differential diagnoses for the patient are Dyslipidemia and Diabetes due to the patient’s food diet, high-
density lipoprotein, and increased blood pressure (Forouhi & Wareham, 2019). Given that the patient's tests for
dyslipidemia and diabetes came out negative, obesity is more likely to be present. Although some of the
disease's symptoms were visible in the patient, these conditions were not considered present because the
patient's body mass index was discovered to be greater than normal, a hallmark of obesity.
Diagnostic plans include Fasting blood glucose and lipid panel; it is recommended that people with
obesity be evaluated for concurrent risk factors such as diabetes and dyslipidemia (Mansi & Hansard, 2021).
Hemoglobin A1 and average blood sugar levels are measured. The primary test for assisting the medical staff in
managing a patient's diabetes is often used to identify prediabetes and diabetes. Repeat the labs in 3 months.
Treatment plans include statin medication, which significantly lower mortality and CVD events in
people with an increased risk of CVD (without a past CVD incident) (Mansi & Hansard, 2021). Weight loss:
recommend burning more calories than is taken by reducing calories, increasing physical activity, or both. To
lower the risk of ASCVD, engaging in aerobic physical activity for at least 150 cumulative minutes per week of
moderate-intensity or 75 minutes per week of vigorous-intensity is advised. Increase fiber intake in people who
3
are overweight or obese who consume a calorie-restricted diet, and dietary fiber consumption increases weight
loss and dietary adherence regardless of macronutrient and calorie intake (Cohen & Gadde, 2019).
References
Chooi, Y. C., Ding, C., & Magkos, F. (2019). The epidemiology of obesity. Metabolism, 92, 6-10.
Cohen, J. B., & Gadde, K. M. (2019). Weight loss medications in the treatment of obesity and hypertension.
Current hypertension reports 21(2), 1–9.
Forouhi, N. G., & Wareham, N. J. (2019). Epidemiology of diabetes. Medicine, 47(1), 22–27.
Mansi, I. A., Chansard, M., Lingvay, I., Zhang, S., Halm, E. A., & Alvarez, C. A. (2021). Association of statin
therapy initiation with obesity progression: a retrospective matched cohort study. JAMA Internal
Medicine, 181(12), 1562-1574.
Case Analysis Tool Worksheet
Student's Name:
Case ID:
I. Epidemiology/Patient Profile
Mr Harrison James, a 45-year-old Caucasian male, is exhibiting obesity. He says he does not smoke but
admits to drinking beer weekly.
II. Prioritized Cues from Hx and PE.
(Do not include lab, x-ray, or other diagnostic test results here.)
• Tier 1: The cues (may be positive or negative) that contribute most to the diagnosis of the functional problem.
• Tier 2: These are cues of intermediate importance (list only positive cues).
• Tier 3: Of most minor importance (list only positive cues).
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Tier 1
Tier 2
Tier 3
He is obese
Pulse is 74 beats/minute
He divorced for two years
His last office visit: weight 208lbs
Height is 170 cm (67 in)
He is an accountant
He had a normal weight until a
few years ago.
Their blood pressure is 124/68
mmHg
A review of systems was
unremarkable
His waist circumference is 42
inches
Do not take any medication.
He sleeps well at night but has no
reports of snoring.
Regularly consume fast food for
dinner, a burger and fries for
lunch, and a doughnut and coffee
for breakfast.
He does fall asleep easily during
the day; he frequently feels tired.
Hyperlipidemia and high blood
pressure run in his family.
Has a sedentary life both at work
and home
He does not smoke
He drinks a beer or two once per
week.
Over time, the majority of the
family's men acquire weight.
No family history of diabetes
No breathlessness or modifications
in exercise tolerance
He experiences no pressure,
tightness, or discomfort in his
chest.
There is no edema and no walking
or resting leg pain.
There are no focal neurologic
symptoms, headaches, or blurred
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vision.
At the age of 68, his father
experienced a heart attack.
III. Problem Statement
Harrison James, a 45-year-old Caucasian man, visited the healthcare facility for a wellness checkup. He lives
a sedentary lifestyle at work since he works as an accountant. He eats fries and a burger for lunch and fast
food for dinner. His breakfast consists of coffee and a doughnut. He now weighs 220 pounds, up from 208
pounds at his previous medical appointment. He argues that because of his exhaustion from work, he does not
exercise. He also alleges chronic fatigue and difficulty sleeping during the day but can at night. He does not
smoke but admits to drinking beer once a week. His father experienced a heart attack at the age of 68. He has
no family history of diabetes.
IV. Differential Diagnosis
Based on what you have learned from the history and physical examination, list up to 3 diagnoses that might
explain this patient's complaint(s).
List your most likely diagnosis first, followed by two other reasonable possibilities. For some cases, fewer than
three diagnoses will be appropriate.
Then, enter the positive or negative findings from the history and the physical examination that support each
diagnosis.
Leading dx:
Obesity
E66. 9 (Chooi & Ding, 2019).
History Finding(s)
Physical Exam Finding(s)
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He is obese
Their blood pressure is 122/64 mmHg.
His last office visit: weight 208lbs
An increased waist circumference of 42 inches
He had a normal weight until a few years ago.
LDL-141 mg/dl.
Total cholesterol -206 mg/dl
No family history of diabetes
Review of system- unremarkable.
Eats fast food every night for supper, a burger and
fries every day for lunch, and a doughnut and coffee
every morning.
Weight 220 lbs
Hyperlipidemia and high blood pressure run in his
family.
Has a sedentary life both at work and home
He does not smoke
He drinks a beer or two once per week.
Over time, the majority of the family's men acquire
weight.
At the age of 68, his father experienced a heart
attack.
No breathlessness or modifications in exercise
tolerance
He experiences no pressure, tightness, or discomfort
in his chest.
There is no edema and no walking or resting leg pain.
There are no focal neurologic symptoms, headaches,
or blurred vision.
Alternative dx:
Dyslipidemia
E78. 5 (Vekic & Zeljkovic, 2019).
History Finding(s)
Physical Exam Finding(s)
He is obese
His blood pressure is 122/64 mmHg.
His last office visit: weight 208lbs
An increased waist circumference of 42 inches
He had a normal weight until a few years ago.
LDL-141 mg/dl.
Total cholesterol -206 mg/dl
No family history of diabetes
Review of system- unremarkable.
Eats fast food every night for supper, a burger and
Weight 220 lbs
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fries every day for lunch, and a doughnut and coffee
every morning.
Hyperlipidemia and high blood pressure run in his
family.
Has a sedentary life both at work and home
He does not smoke
He drinks a beer or two once per week.
Over time, the majority of the family's men acquire
weight.
At the age of 68, his father experienced a heart
attack.
No breathlessness or modifications in exercise
tolerance
He experiences no pressure, tightness, or discomfort
in his chest.
There is no edema and no walking or resting leg pain.
There are no focal neurologic symptoms, headaches,
or blurred vision.
Alternative dx:
Diabetes E08-E13 (Forouhi & Wareham, 2019).
History Finding(s)
Physical Exam Finding(s)
He is obese
His blood pressure is 122/64 mmHg.
His last office visit: weight 208lbs
An increased waist circumference of 42 inches
He had a normal weight until a few years ago.
LDL-141 mg/dl.
Total cholesterol -206 mg/dl
No family history of diabetes
Review of system- unremarkable.
Eats fast food every night for supper, a burger and
fries every day for lunch, and a doughnut and coffee
every morning.
Weight 220 lbs
Hyperlipidemia and high blood pressure run in his
family.
8
Has a sedentary life both at work and home
He does not smoke
He drinks a beer or two once per week.
Over time, the majority of the family's men acquire
weight.
At the age of 68, his father experienced a heart
attack.
No breathlessness or modifications in exercise
tolerance
He experiences no pressure, tightness, or discomfort
in his chest.
There is no edema and no walking or resting leg pain.
There are no focal neurologic symptoms, headaches,
or blurred vision.
V. Explanation of Diagnostic Plan
(including tests, labs, imaging studies, etc.)
and Treatment Plan in
prioritized order:
Diagnostic Plan
Rationale
Fasting blood glucose and cholesterol (Nichols &
Philip, 2019).
People with obesity should be screened for co-
occurring risk factors such as diabetes and
dyslipidemia, according to the third Adult Treatment
Panel of the National Cholesterol Education Program
(Nichols & Philip, 2019).
Lipid Panel (Alzahrani & Baig, 2019).
According to the third Adult Treatment Panel
recommendations from the National Cholesterol
Education Program, patients with obesity should be
assessed for concomitant risk factors, such as
diabetes and dyslipidemia (Alzahrani & Baig, 2019).
Hemoglobin A1 after three months (Fabris &
The typical blood sugar levels are calculated. One of
9
Heinemann, 2020).
the often-used tests to detect prediabetes and diabetes
is the major test for aiding the medical team in
managing a patient's diabetes (Fabris & Heinemann,
2020).
Repeat the labs in 3 months.
Treatment Plan
Rationale
Statin Therapy (Mansi & Hansard, 2021).
Statin medication has been shown to significantly
lower mortality and CVD events in people with an
increased risk of CVD (without a past CVD incident)
(Mansi & Hansard, 2021).
Exercise (Whelton & McAuley, 2021).
To lower the risk of ASCVD, specialists recommend
engaging in aerobic exercise for at least 150 minutes
a week at a moderate effort or 75 minutes a week at a
vigorous intensity. While physical activity is
important in any weight loss program, combining
food and exercise produces positive results rather
than relying solely on numbers. This is the
foundation of care (Whelton & McAuley, 2021).
Dieting, e.g., increased fiber intake
and reduced saturated fat (Whelton & McAuley,
2020).
Encourage the patient to use food diaries or activity
records, read food labels, pay attention to portion
sizes, and develop a healthy long-term eating strategy
that results in a modest 5–10% body weight loss. In
people with overweight or obesity who consume a
calorie-restricted diet, dietary fiber consumption
increases weight loss and dietary adherence
regardless of macronutrient and calorie intake
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(Whelton & McAuley, 2020).
Weight loss (Cohen & Gadde, 2019).
By lowering calories, upping physical activity, or
both, the body can burn more calories than it
consumes. Weight loss helps to lower blood pressure,
levels of triglycerides, risk of heart disease, and risk
of heart disease. It also helps in gaining better sleep
(Cohen & Gadde, 2019).
Follow up in 3 months.
To reassess the lipid profile, weight-loss progress,
and diet.
I have adhered to the honor system: _______________________________
(Students Signature)
11
References
Alzahrani, S. H., Baig, M., Aashi, M. M., Al-Shaibi, F. K., Alqarni, D. A., & Bakhamees, W. H. (2019).
Association between glycated hemoglobin (HbA1c) and the lipid profile in patients with obesity at a
tertiary care hospital: a retrospective study. Metabolic syndrome and obesity: targets and therapy, 12,
1639.
Chooi, Y. C., Ding, C., & Magkos, F. (2019). The epidemiology of obesity. Metabolism, 92, 6-10.
Cohen, J. B., & Gadde, K. M. (2019). Weight loss medications in the treatment of obesity and hypertension.
Current hypertension reports 21(2), 1–9.
Fabris, C., Heinemann, L., Beck, R., Cobelli, C., & Kovatchev, B. (2020). Estimating hemoglobin A1c from
continuous glucose monitoring data in individuals with obesity: Is time in a range all we need?
Forouhi, N. G., & Wareham, N. J. (2019). Epidemiology of diabetes. Medicine, 47(1), 22–27.
Jacobsen, S. S., Vistisen, D., Vilsbøll, T., Bruun, J. M., & Ewers, B. (2020). The quality of dietary carbohydrates
and fat is associated with better metabolic control in persons with = obesity. Nutrition Journal, 19(1), 1-
8.
Mansi, I. A., Chansard, M., Lingvay, I., Zhang, S., Halm, E. A., & Alvarez, C. A. (2021). Association of statin
therapy initiation with obesity progression: a retrospective matched cohort study. JAMA Internal
Medicine, 181(12), 1562-1574.
12
Nichols, G. A., Philip, S., Reynolds, K., Granowitz, C. B., & Fazio, S. (2019). Increased residual cardiovascular
risk in patients with obesity and high versus normal triglycerides despite statin‐controlled LDL
cholesterol. Obesity and Metabolism, 21(2), 366–371.
Vekic, J., Zeljkovic, A., Stefanovic, A., Jelic-Ivanovic, Z., & Spasojevic-Kalimanovska, V. (2019). Obesity and
dyslipidemia. Metabolism, 92, 71-81.
Whelton, S. P., McAuley, P. A., Dardari, Z., Orimoloye, O. A., Brawner, C. A., Ehrman, J. K., ... & Blaha, M. J.
(2020). Association of BMI, fitness, and mortality in patients with obesity: evaluating the obesity
paradox in the Henry Ford exercise testing project (fit project) cohort. Obesity care, 43(3), 677–682.
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