A man with a bmi of 38 and a waist size of 48 inches is seen in the clinic for an annual well check-up. the primary care np orders laboratory tests and notes a fasting plasma glucose of 110 mg/dl, triglyceride level of 220 mg/dl, and high-density lipoprotein level of 40 mg/dl. the man's blood pressure is 160/110 mm hg. the man has a history of cardiovascular disease and tells the np he has tried to lose weight numerous times. the np should consider:

That This man's BMI and waist circumference indicate that he is obese, and he has more than three indicators of metabolic syndrome. Because of his history of cardiovascular disease, his past failed attempts to lose weight, and his elevated blood pressure, treatment is indicated. Phentermine would be a good initial choice but carries significant risks in patients with cardiovascular disease and high blood pressure. Orlistat is a safer choice for pharmacologic therapy. An oral antidiabetic agent would be used if insulin resistance were present, but his fasting plasma glucose is normal. A strict change in diet is warranted but in this case should be combined with pharmacologic treatment.