Susie is a 61-year-old office worker who is referred to a dietitian for weight-loss advice. Susie’s weight is 124kg and BMI is 49kg/m². She has a history of asthma, osteoarthritis, psoriasis, hypertension, anxiety and depression.

A recent sleep study showed obstructive sleep apnoea, and she has trialled CPAP with limited success. Her exercise tolerance is limited to mobilising 400m as a result of knee pain.

She is not keen on either weight-loss surgery or pharmacotherapy because of the cost. However, Susie is extremely motivated to try intense lifestyle changes again after many previous unsuccessful attempts.

She is currently prescribed atenolol 25mg daily, budesonide–formoterol (Symbicort Rapihaler) 200/6 two puffs twice daily and duloxetine 60mg daily.