For a 57-year-old Indigenous male with BMI 40 and truncal obesity, a family history of type 2 diabetes, hypertension, dyslipidemia, and premature coronary disease, what are his priority health concerns/risk factors, what health screening plan (including focused exam, diagnostic tests, and referrals) is appropriate, and what individualized medical weight‑management care plan (non‑pharmacologic and pharmacologic, with a sample prescription) should be implemented?

{
  "question": "Case 1 – [PATIENT]\n[PATIENT] is a 57-year-old Indigenous male who lives in [LOCATION]. He is coming to the clinic today for a periodic health exam. He expresses interest in medical weight management.\nThe NP starts to gather health information:\nSocial Hx:\nLives in a small apartment with his partner\nMarried with 2 adult children from a previous relationship, four grandchildren.\nWorks as a high school teacher.\nMed hx: occasional tension headaches\nSurgical hx: ORIF right femur at age 18\nFamily Hx:\nFather: died at age 65 of a sudden heart attack, history of poorly controlled type 2 diabetes, dyslipidemia, hypertension\nMother: 75 years old, diabetes type 2, hypertension.\nSibling aged 42 has diabetes, hypertension, and chronic kidney disease.\nTwin siblings age 50, with dyslipidemia, hypertension and prediabetes.\nAllergies: macrolides, ragweed\nImmunizations: Last tetanus 3 years ago. Last flu vaccine 6 months ago. Covid vaccines x2. Received all childhood vaccines.\nMedications: Advil prn, occasionally takes a multivitamin\nFunctional Health Patterns:\nFormer ½ PPD of cigarettes x 30 years, quit 2 years ago.\nDiet: No restrictions, limited fruit/veg intake due to costs. 2 coffees a day.\nSleep: Sleeps well. Partner says he snores very loudly, and they have to move onto the sofa sometimes.\nExercise: Stationary bike x 20 minutes 2-3 times a week during winter months, in the spring and summer walks daily with his partner as well.\nAlcohol: None.\nDrugs: None\nStress: Handles stress by talking to his partner or painting.\nROS: No complaints. He is a bit concerned about his health due to his weight and family history.\nExam: BMI 40 with truncal obesity\nQuestions\n1. 2. 3. Identify your priority health concerns or risk factors from the information provided. Include rationale and supporting evidence for your selection\nGiven just the above information, devise a health screening plan for [PATIENT], including focused exam, appropriate diagnostic testing, or referrals. Provide rationale (remember to cite your sources). You may want to use a table to organize your information. You may use point form in the table.\nDevise a medical weight management care plan for [PATIENT]. Include non-pharmacologic and pharmacological interventions and recommendations. Be specific, and ensure your plan is individualized for this patient. Include a sample prescription in an appendix"
}