Obesity and cardiovascular disease.

Case study: A 43-year-old man with a long history of obesity presented to our Weight Management Center 5 years after being disabled in a motor vehicle accident and gaining weight to a lifetime high of 269 kg and body mass index (BMI) of 85 kg/m. His comorbidities were hypertension, obstructive sleep apnea, gastroesophageal reflux disease, gout, and osteoarthritis, and he had recently developed type 2 diabetes mellitus. Medications used included metformin, glyburide, losartan, hydrochlorothiazide, and diltiazem. He was motivated and met criteria for weight loss via a surgical intervention. Preoperatively, he was placed on a high-protein diet plus an appetite suppressant (phentermine) to achieve 10% weight loss. His weight declined, but he developed new-onset atrial fibrillation 3 weeks later, which was thought to be related to phentermine use and was cardioverted back to sinus rhythm. Several months later, the patient underwent gastric bypass bariatric surgery with a preoperative weight of 252 kg. His type 2 diabetes mellitus resolved immediately after surgery, as did his gastroesophageal reflux and hypertension. Ten months after surgery, his weight was down to 177 kg (BMI 56 kg/m) with hemoglobin A1c of 5.9%, fasting blood glucose of 82 mg/dL, and blood pressure of 137/ 82 mm Hg, and he was no longer taking any medication.