Conversation about weight to avoid generating stigma

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Reference no: EM133881387

Question

Laura is a 41-year-old female who is coming to see you as her new primary care provider. She has not had a physical in almost 2 years. She is 5'5" tall and weighs 180 lbs. Her BMI is 30. Her waist circumference is 37". Her blood pressure today is 130/85. She has hyperlipidemia, with her triglycerides at 185, total cholesterol 200, HDL 45, and LDL 120. You note an elevated fasting glucose at 112. She has a history of HTN and bipolar disorder and is managed by psychiatry. She is currently stable on her medication - she has been on Risperdal for 2 years. She would like you to take over prescribing for all medication but Risperdal. She denies alcohol, tobacco, and other substance use. She is not happy with her weight and states she has gained 15 lbs. in the last year. She was of normal weight as a teen, but weight has crept up on her since having children. She is frustrated with herself, stating "I just cannot lose any weight. This is all my fault. I cannot control myself. I am a bad mother."

On exam, you discover traces of lower extremity edema and brown discoloration of the medial ankles.

Her medication list is as follows:

Risperdal 2 mg PO BID.
Depo-Provera 150 mg IM q3mo
Ramipril 5 mg PO QD
Amlodipine 2.5 mg PO QD
Propranolol 20 mg PO QD PRN for anxiety

Questions

1. How do you respond to Laura's feelings? How would you start the conversation about weight to avoid generating stigma?

2. What are your concerns regarding Laura's history and physical findings noted above? Be detailed.

3. Analyze her current medications. Could any of them be causing weight gain? What would you change?

4. What are first steps that you would encourage to promote weight loss?

5. How would you discuss and encourage the addition of physical activity into Laura's daily/weekly routine? Discuss how you would set reasonable expectations and be mindful of her current exercise tolerance/capacity.

Reference no: EM133881387

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