The patient is a 32-year-old obese woman who came to the clinic with weight concerns. She is 165 cm tall and her weight is 113 kg.  She is complaining of sleep apnea, PCO and dissatisfaction with her body shape. She is a high-school teacher married for 5 years. She doesn't use any contraceptive methods for the past 4 months and she had no prior pregnancies. She doesn't smoke or use any drugs. She likes to try diets and exercise to lose weight. She completed the four square step test in 14 seconds. Her BP: 130/80, HR: 195/min and her BMI is: 41.54. Her labs:
FBS: 98 mg/dl
TG: 150 mg/dl
Cholesterol: 180 mg/dl
LDL: 90 mg/dl
HDL: 35 mg/dl
Her cardiac assessment is normal. Her joints and ROM are within  normal.