In June of 2013, Mrs. Jones, a 49-year-old post-menopausal, Caucasian woman presented to
her primary care physician (PCP) reporting a new history (5–6 weeks) of fatigue, weakness,
hyperphagia, excessive urination, dyspnea on exertion, lethargy, depression, and excessive
thirst. She is a non-tobacco user with no known history of DM, hypertension, asthma,
pulmonary disease, or cardiovascular disease (CVD). Mrs. Jones has had arthroscopy of the left
knee due to persistent pain, particularly on climbing stairs that revealed evidence of mild
arthritis but no ligament or meniscus tears.
Current medications include Premarin®, 0.625 mg/day and Claritin® for allergies. She takes a
multivitamin each day and has used over the counter weight loss supplements including herbal
phen/fen (Ma Huang or ephedra) as well as St. John’s Wort. She also has taken Echinacea,
Astragalus, and Glutamine.
On physical examination, Mrs. Jones’ PCP found no significant abnormalities of major systems
and organs. Mrs. Jones reports no regular exercise or physical activity. She works at a
manufacturing plant and her job is generally sedentary. She does some light flower and
vegetable gardening in the spring, summer, and fall, but no more than 30 minutes, 2-3 days per
week. She reports a weight gain of approximately 50 lbs since giving birth to her third child
sixteen years ago. Diet history reveals high fat, high saturated fat, high sodium diet; low in
complex carbohydrates and fiber; skips breakfast; eats out frequently.
Family hx of CVD, DM (type 2), obesity, dyslipidemia.
Ht: 5’2”; Wt: 232lbs; BMI: 42.4; BP: 146/94
Labs: FBS=122 mg/dl; Chol=242 mg/dl; LDL=134 mg/dl; HDL=39 mg/dl; Albumin=3.9 g/dl
and effectiveness in weight loss and maintenance.