Obesity Medicine

A 56-year-old was seen in the ED after 4 days of hemoptysis and intermittent left chest pain. He also complained of exertional dyspnea and arthralgias. He had been treated for “pneumonia” twice during the past month. Histories were unremarkable.

This 66-year-old black woman presented with a 2-year history of a painless skin eruption. She stated that her skin had “changed overnight” while she was caring for her mother who had been hospitalized.

For years, GI toxicity and risk of bleeding were the issues of most concern when deciding to prescribe an NSAID. The cardiac effects associated with these drugs were considered a positive in that least some have been shown to provide prophylaxis against myocardial infarction.

It should come as no surprise. The combination of the obesity epidemic and delayed childbearing in the US has fostered a novel mini-epidemic. Chronically hypertensive women are becoming pregnant in greater numbers. The trend is not just a perinatal and obstetric problem.

In a recent JAMA commentary, the authors suggest that state intervention might be considered in severe instances of childhood obesity.

A 66-year-old woman presented with a 2-day history of acute onset of redness, pain, and swelling of the right breast.

Acanthosis nigricans is a nonspecific increase of the thickness of the prickle cell layer of the skin and most commonly seen in obese persons.

A 61-year-old man with arthritis and an 80-pack-year smoking history presented with fever, dyspnea, and productive cough of a week’s duration that did not respond to outpatient treatment with levofloxacin.

An 88-year-old man presents with a 2-month history of a non-healing ulcer on his right lower limb.

An 88-year-old woman was brought to the emergency department after she choked on a piece of meat. She had dysphagia of many years’ duration and progressive weight loss over the past 5 years.

For 3 weeks, a previously healthy 24-year-old man had repeated episodes of nonbloody, nonbilious emesis. He denied dysphagia, but he did report a 40-lb (18-kg) weight loss and heartburn.

For 4 weeks, a 49-year-old man has had progressively worsening pain between his scapulae and in the lower part of his neck. The pain is now severe, and he takes high doses of acetaminophen and NSAIDs for relief.

Systemic inflammation has been identified as a risk factor for the development of heart failure in population studies. In the 5-year prospective MESA study, researchers from Johns Hopkins Hospital in Baltimore recorded a baseline nonspecific marker of systemic inflammation, C-reactive protein (CRP).

A 48-year-old woman was hospitalized for acute-onset abdominal pain. She had a history of adult-onset Still disease and severe osteoarthritis. She had been taking 650 mg of aspirin every 4 hours to relieve her arthritis pain and fevers.

On December 18, 2005, Ariel Sharon, Prime Minister of Israel, experienced the sudden onset of aphasia. Despite being overweight, he had none of the traditional risk factors for cerebrovascular disease-hypertension, history of smoking, diabetes, or elevated cholesterol levels.

For 20 years, a lesion has been slowly growing on the penis of a 51-year-old man. He has noted bleeding and a foul-smelling discharge from the mass. Recently, the patient experienced a 30-lb weight loss. He has had 5 sex partners in his lifetime but has been monogamous for the past year.

17-Year-old girl with a 7-month history of small, red papules on her arms and thighs. Rash is not painful or itchy. Otherwise in good health.

A 72-year-old obese man with chronic atrial fibrillation, hypertension, hyperlipidemia, and a history of tobacco use presented for a routine office visit. A year earlier, he began to experience recurrent chest pain, but an ECG had shown normal T waves.

Chronic fatigue syndrome (CFS) is a distinct disorder characterized by debilitating and often recurrent fatigue that lasts at least 6 months but more frequently lasts for longer periods. Patients with CFS experience overall physical, social, and mental impairments and may subsequently qualify for medical disability.

A 41-year-old woman presents to the emergency department with chest pain and dysphagia. Routine laboratory studies reveal profound neutropenia. She denies recent fever, chills, or weight loss.

For 4 months, a 45-year-old man with a history of alcohol abuse had made multiple visits to the emergency department (ED) and a dermatology clinic for evaluation of a diffuse, scaly, and intensely pruritic rash. The rash, which was photosensitive, had started on his upper extremities and spread proximally to the trunk and lower extremities.