Bahisa is a 64-year-old, divorced, Pakistani American who identifies as a hetero

Bahisa is a 64-year-old, divorced, Pakistani American who identifies as a heterosexual, cisgender woman. She meets today for the first time a newly hired AGPCNP at a concierge internal medicine practice. She recently retired after 40 years working as a teaching assistant at a local elementary school. She is not sexually active nor romantically involved with anyone since her divorce two years ago.
Bahisa shares she has no major medical history. Her family history is notable for hypertension (both parents); diabetes mellitus (paternal grandmother and father); coronary artery disease (CAD; her grandfather died of a myocardial infarction at age 59). Her body mass index (BMI) is 40.
Since retiring, Bahisa reports that she enjoys various activities, including reading, gardening, shopping online, and watching Netflix and other streaming providers on television. Bahisa asserts she keeps physically active by spending two to three days every week with her young grandchildren (ages 2, 4, and 6). However, she later admits that she does not engage in regular exercise.
Bahisa describes her food intake as “healthy,” and on most days she skips breakfast. She has had a life-long aversion to many fruits. Since retiring, Bahira reveals she has felt happy on most days. However, she explains feeling more tired and lethargic about two to three times every week. She states that her life has always experienced some minor ups and downs, but she is not concerned. She considers such ups and downs as an expected part of every person’s life.
Her vitals are reviewed:
Blood pressure: 155/86
Pulse: 74 bpm
Respirations: 12
Height: 5’0 feet (or 60 inches tall)
Weight: 205 pounds
BMI: 40.23 kg/m2
Pulse oximetry: 96% on room air
Waist circumference: 55 inches
Hip circumference: 52.5 inches
Waist-to-hip ratio: 0.98 inches
Medication list:
One multivitamin daily
One calcium tablet with vitamin D daily
Tylenol one to two tablets PRN for intermittent lower back pain
Questions:
1. Is Bahisa overweight or obese? What category does her BMI fall into? How would you address her BMI?
2. Is there a need to address Bahisa’s family history? What cardiovascular risk factors might she have?
3. What has led to Bahisa’s obesity? Is she a candidate for weight loss? How would you present her with a plan for weight loss? What would this include?
4. What dietary advice and exercise regimen would you prescribe? What lifestyle changes would you recommend? When would you schedule her next follow-up appointment?