Reducing multimorbidity in metabolic syndrome
Mary, a 58-year-old woman on a disability pension, has complex multimorbidity encompassing bipolar disorder, PTSD, chronic back pain and morbid obesity.
She presents to her GP complaining that she is unable to lose weight and her quality of life is poor. In her own words, Mary is ‘ready to lie down and die’.
She takes multiple medications that include tramadol, quetiapine and pregabalin.
She is an ex-smoker and consumes no alcohol.
Despite dieting and regular exercise, Mary says she is concerned about progressing to