instruction: hello doctor I am tired of being fat and I am tired of diets after a diet I gain double and every time it is harder to lose I am desperate lonely and depressed I do not want to be fat for my entire life I am only 26 and have always struggled with my weight please help
output: hello I can imagine the level of your frustration regarding your weight yes it is nearly impossible to keep reduce weight and maintain diet and exercise I may not be able to give you a composite plan of action for your weight reduction since it is not basically a one day consultation task in fact it is a long term commitment towards yourself and towards a multidisciplinary team inclusive of a dietician bariatric endoscopist gastroenterologist behavioral therapist and lastly a bariatric surgeon so I would give you facts and figures for the existing evidence of weight reduction therapies remember your current body mass index mi is 34 the goal of any weight reduction treatment is to reduce weight to optimal ranges where the physical and psychological well being of a person is maintained now anybody whose body mass index mi is more than 40 should straight away consider bariatric intervention in the form of endoscopic or surgical morality and anybody whose mi is 35 but having other conditions such as uncontrolled diabetes coronary artery disease heart disease or lung dysfunction lung hypertension and sleep disorders should undergo interventions but you see not all person fit into above category many have mi less than 35 such as in your case and having very troubling symptoms among such people individualized approach is employed whether medicinal use or endoscopic or surgical intervention diets and regular weight reduction exercises do help to reduce weight by to 10 all medicines which are currently in use help reduce weight by 10 to 20 certain endoscopic bariatric procedures such as balloon placement in stomach and sleeve gastrectomy does help reduce weight around 25 and lastly surgical procedures such as metallic rings around the stomach via laparoscopy and surgical sleeve gastrectomy and surgical roux bypass help to reduce weight by 30 to 35 the figures are ranges they vary significantly in individual cases I also want you to understand that these interventions should be accompanied with optimal dieting and exercise even after surgery or medicinal therapy otherwise the weight can frequently recur to original ones this above description is only to make you understand and figure out things I can recommend you to start with dieting keeping your calories well below 1500 cal daily running swimming and weight lifting on a regular basis I also suggest you to meet a dietician on icliniq or otherwise in person to get a diet plan with respect to your calorie requirement I can suggest you some medicinal treatment but they are prescription medicine may not be ot and the course has to be taken for at least six months to see the effect naltrexone bupropion contrave is proven and fda approved and can be started in your case but I want you to provide more information about your health as I can assess your condition first and treat aimfully rather adding more harm to your health because these medications have some side effects and they should be kept in mind before giving it therapeutically I also want to know about family support any occupational therapist available near your vicinity your current job status and medical health insurance and also information whether the cost of these medicines is covered or not until that time you follow up I want you to get the following blood tests to better know the impact of your obesity on bodily systems I hope this helps obesity complete blood count ash thyearoid stimulating hormone ft3 ft4 liver function test fasting lipid profile serum cop reactive protein albumin total protein and ag ratio arterial blood gases urine detail report and urine for albumin will decide after further information is provided and after investigation thoroughly for any underlying metabolic complications