Patient background
A 52-year-old woman presents for longitudinal management of obesity. Her BMI is 36.1 kg/m². She reports progressive weight gain over the past 15 years, with multiple attempts at calorie restriction and structured exercise programs resulting in short-term weight loss followed by recurrent weight regain.
Medical history and clinical findings
Her medical history includes hypertension and dyslipidemia, both well controlled with medication. She does not have diabetes. She works long hours with frequent travel and reports irregular meal timing, stress-related eating, and difficulty sustaining lifestyle changes over time. She expresses reluctance toward injectable therapies, citing needle aversion and concerns about maintaining long-term treatment.
Physical examination demonstrates central adiposity without features suggestive of secondary endocrine causes.
Laboratory findings
Laboratory evaluation reveals normal fasting glucose, an HbA1c of 5.6%, mildly elevated triglycerides, and normal hepatic and renal function. Secondary contributors to obesity are excluded.
Assessment and diagnosis findings
This patient meets criteria for chronic obesity with adiposity-related cardiometabolic risk factors. Obesity is discussed as a chronic, relapsing disease requiring sustained, individualized management rather than episodic intervention. Prior lifestyle-only approaches have not produced durable weight loss.
During shared decision-making, pharmacologic therapy is considered as part of a comprehensive long-term care plan alongside nutrition counseling, behavioral strategies, and physical activity, consistent with guideline-based recommendations for chronic obesity management. Emerging oral GLP-1 receptor agonists are discussed in a future-oriented context, given their effects on appetite regulation and satiety and their potential to reduce treatment burden for patients with functional or emotional barriers to adherence.
Given the heterogeneity of patient needs and real-world constraints, long-term obesity management often requires individualized clinical judgment, structured follow-up, and ongoing reassessment to support sustained weight maintenance and reduce the risk of weight regain.
- Which factors most strongly influence your decision to initiate pharmacotherapy for obesity in similar patients?
- What functional or emotional barriers most commonly limit long-term adherence to obesity treatment in your practice?
- What challenges have you encountered when sustaining lifestyle interventions alongside pharmacologic therapy?
