Weight Loss Follow Up

History of Present Issue

Subjective

• 46 yo F (Sarah Jenkins, DOB: 14/05/1978, MRN: 849-201-44) returns for 1-month weight management f/u. Reports losing 2.7 kg since starting lifestyle modifications and pharmacotherapy on 18/09/2024. Pleased with progress; notes improved energy and reduced bilateral knee pain.
• Adhering to 1,500 kcal/day Mediterranean-style diet. Prioritizing lean proteins and vegetables. Eliminated sugar-sweetened beverages. Occasional weekend grazing remains a challenge.
• Walking 30 mins 4x/week during lunch breaks. Recently added light resistance training 2x/week at home.
• Reports mild transient nausea 1–2 days post-injection; no emesis, abdominal pain, or constipation. Denies palpitations or hypoglycaemic sx.
• semaglutide (Wegovy®) 0.25 mg SC once weekly, lisinopril (Prinivil®) 10 mg PO daily, cholecalciferol (Vitamin D3) 1,000 IU PO daily.
• Works as an accountant (sedentary). Supportive spouse who cooks dinner. Non-smoker, 1–2 standard alcoholic drinks/month. Sleeping 7 hrs/night.

Objective

• Wt: 94.3 kg (baseline 97.0 kg), Ht: 165 cm, BMI: 34.6 kg/m² (down from 35.6 kg/m²), Waist circumference: 101 cm, BP: 124/78 mmHg, HR: 72 bpm, Temp: 36.8 °C.
• Gen: Alert, NAD. CV: RRR, no murmurs. Resp: CTAB. Abd: Soft, non-tender, non-distended, normoactive BS, no organomegaly. Ext: No peripheral oedema.
• Fasting labs (15/10/2024): HbA1c 5.8 %, FBG 98 mg/dL, TSH 2.1 mIU/L, eGFR > 90 mL/min/1.73m², AST 22 U/L, ALT 26 U/L, Total Chol 195 mg/dL, Triglycerides 140 mg/dL, HDL 48 mg/dL, LDL 119 mg/dL.

Assessment

• Class I obesity (BMI 34.6 kg/m²), prediabetes, and essential HTN. Responding well to initial therapy with 2.8 % total body weight loss over 4 weeks. Tolerating GLP-1 RA well with minimal GI side effects. BP well-controlled.
• Sedentary occupation and weekend snacking triggered by work stress.

Plan

• Continue 1,500 kcal/day high-protein (> 90 g/day), high-fibre diet. Recommend meal prepping on Fridays to mitigate weekend grazing. Increase brisk walking to 40 mins 4x/week; continue resistance training 2x/week to preserve lean muscle mass. Maintain hydration > 2 L water/day.
• Increase semaglutide (Wegovy®) to 0.5 mg SC once weekly for 4 weeks. Continue lisinopril 10 mg PO daily and cholecalciferol 1,000 IU PO daily.
• Refer to registered dietitian (RD) for behavioral strategies regarding stress-eating.
• RTC in 4 weeks (15/11/2024 at 09:30 America/Chicago) to assess tolerance of dose escalation and weight trajectory. Repeat CMP and HbA1c in 3 months. Call clinic if severe abdominal pain or persistent vomiting occurs.