Table of Contents
Common Questions
Chat with CodyMD
Cody's Chat with Patient
Cody's AI Summary
Top 3 AI Diagnosis List
Review by Dr Albert DiPiero
Dr. DiPiero Video Guide to this Case Study
Resource Center
Testimonials
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Case Study
Meet your host
Albert DiPiero, MD MPH FACP
I am a co-founder and the Chief Medical Officer at CodyMD and your host for this edition of Cody Grand Rounds. I have been a practicing physician and faculty member at medical schools for over 26 years.
About The AI Doctor Case Study
CodyMD is a partnership between Human Doctors and AI Doctors. Cody is an AI Doctor who helps thousands of people every day. At each Cody Grand Rounds, I select a real case and review it with Cody, the AI Doctor.
Each case is based on a real patient but has been modified to maintain privacy and to emphasize certain teaching points.
Common Questions
What causes long-term weight gain?
Can stress and mood affect weight gain?
Does alcohol consumption contribute to weight gain?
How can hypothyroidism affect weight?
Can changing diet and exercise habits help with weight management?
What role do eating habits play in weight changes?
How do AI-driven tools assist in diagnosing weight gain?
How can AI Doctors support weight management plans?
Chat with CodyMD
Click the button below to initiate a conversation with CodyMD, your AI Doctor.
Cody's Chat with Patient
Below is a conversation transcript between the patient and our AI Doctor CodyMd.
Cody, the AI Doctor
Hi, I understand you're here to discuss concerns about weight gain. Is that right?
Patient
Yes, that's right. It's been quite frustrating.
Cody, the AI Doctor
I’m here to help. Could you tell me how long you've been experiencing this weight gain?
Patient
It started around 15 years ago when I began college, but it’s been a gradual thing.
Cody, the AI Doctor
That’s quite a long time. Have you noticed any changes in your activity levels or lifestyle since then?
Patient
Definitely. I used to be really active, playing volleyball and soccer. But now, I barely have time or energy to exercise, especially with my demanding job as a marketing executive.
Cody, the AI Doctor
I see. And how has your diet changed over those years?
Patient
Back then, I would cook a lot of my meals—mostly plant-based. But these days, I'm eating out much more. It's mostly fast food or processed stuff, especially when I'm stressed or short on time.
Cody, the AI Doctor
It sounds like your diet has shifted quite a bit. Do you currently monitor your calorie intake?
Patient
Not really. I've tried a couple of times, but it's hard to stick with it. I end up choosing quick, high-calorie options a lot without really thinking about it.
Cody, the AI Doctor
Understandable. How have your mood and energy levels been over this time?
Patient
I often feel fatigued and sad about the weight gain. Stress from work just gets overwhelming. Some days, I struggle to find motivation for even simple things.
Cody, the AI Doctor
That sounds tough. On a day-to-day basis, do you experience any other symptoms, like increased thirst, hunger, or frequent urination?
Patient
No, none of those. I haven't noticed anything like that.
Cody, the AI Doctor
Good to rule those out. How about any changes in hair growth or voice, or new acne that might be of concern?
Patient
No, not really. Nothing unusual with my hair or skin.
Cody, the AI Doctor
And in terms of stress, have you ever felt like it significantly changes your weight or shape quickly, like around your face or abdomen?
Patient
I haven't noticed anything like that. It's been more of a gradual, overall weight gain.
Cody, the AI Doctor
Thanks for that information. Do you consume alcohol often?
Patient
Yes, I have a drink or two most evenings. It started as a way to unwind, but now it's just routine.
Cody, the AI Doctor
Thanks for your honesty. You're on Synthroid for hypothyroidism. Has your medication been stable, and do you get your TSH levels checked regularly?
Patient
Yes, my medication has been stable, and I have my TSH checked every year. My doctor hasn't mentioned any issues.
Cody, the AI Doctor
Given that your thyroid seems well-managed, it's less likely that's the primary factor here. Let me summarize what we’ve discussed to ensure I have everything correct.
Patient
Sure.
Cody's AI Summary
- You are a 33-year-old woman experiencing gradual weight gain over the past 15 years.
- You used to be very active but have significantly decreased physical activity due to a busy work life as a marketing executive.
- Your diet has shifted from mainly plant-based to more processed and high-calorie foods, contributing to your caloric imbalance.
- You experience fatigue, low energy, and feelings of sadness concerning your weight, indicative of stress and possibly depressive symptoms impacting lifestyle choices.
- Your alcohol consumption has increased to one or two drinks per day.
- You're on a stable dose of Synthroid for hypothyroidism, with no other symptoms suggesting hyperandrogenism or hypercortisolism.
- Diabetes-related symptoms like increased thirst, hunger, or urination are absent.
Top 3 AI Diagnosis List
Based on the information and conversations with Cody, we have prepared a top 3 AI Diagnosis List.
1. Weight gain due to caloric imbalance(50 % probability)
Likely related to dietary changes and decreased physical activity.
2. Depression(30 % probability)
Stress, fatigue, and feelings of sadness may indicate depressive symptoms affecting motivation and lifestyle choices.
3. Hypothyroidism(20 % probability)
Less likely due to stable management but could contribute slightly to weight gain.
Review by Dr Albert DiPiero
Dr. Albert DiPiero
After assessing the provided history, the patient's weight has gradually increased, meeting the criteria for obesity with a BMI of 30 or greater. Addressing both psychological and lifestyle variables is vital in managing this condition. CodyMD's AI technology plays a vital role in synthesizing symptoms and providing an initial set of probable diagnoses. Here is my further analysis:
1. Weight gain due to caloric imbalance and life style changes(55% probability)
Upon reviewing this case, the most likely cause of the weight gain appears to be caloric imbalance due to lifestyle changes. The patient reports a significant decrease in physical activity and a major shift from a plant-based diet to consuming more processed and high-calorie foods. These factors, combined with reported daily alcohol intake, suggest a likelihood of caloric surplus, which is contributing to weight gain.
2. Depression(35% probability)
The possibility of depression must not be overlooked. Symptoms of fatigue, low energy, and overall sadness about weight suggest psychological factors could be impacting health choices. It's crucial to address these emotional aspects, as they are likely influencing lifestyle habits that contribute to weight gain.
3. Hypothyroidism(10% probability)
While hypothyroidism is stable under Synthroid treatment, we should consider periodic monitoring given its known link to weight management challenges.
4. Other Considerations:
Polycystic Ovary Syndrome (PCOS) is a common endocrine disorder in women of reproductive age that can contribute to weight gain and difficulties with weight management. It often presents with symptoms such as irregular menstrual cycles, acne, and hirsutism, although these were not specifically noted in the conversation. Obstructive sleep apnea, often associated with excessive weight, can lead to fatigue and could be affecting her overall health and weight. Inquiry into sleep patterns, snoring, and daytime sleepiness could prompt further evaluation. Cushing's Syndrome: Although symptoms like rapid weight gain, especially around the face and abdomen, and skin changes are more characteristic, we might consider this syndrome if there are signs suggesting excess cortisol production.
Steps forward should include adopting a structured exercise regimen and nutritional counseling focusing on sustainable healthy eating.
Next Steps for Evaluation
Diagnostic Testing:
Diagnostic testing should prioritize ruling out metabolic and endocrine factors that might be influencing weight gain. Recommended evaluations include:
Comprehensive metabolic panel to assess overall metabolic health
Hemoglobin A1c for assessing glucose tolerance and insulin resistance
Lipid panel to identify any dyslipidemia
A complete thyroid panel including T3 and T4 to ensure thyroid function is optimally managed
Consider evaluating for depression, possibly trialing behavioral therapy or consulting a mental health professional. Monitoring alcohol consumption is advisable as well.
Potential Treatment Modalities
Lifestyle Modifications
Effective weight management largely hinges on comprehensive lifestyle alterations. Consider the following strategies:
Diet: Advocate a transition back to a plant-based regime, focusing on whole grains, lean proteins, and a higher intake of fruits and vegetables. Encourage opting for home-cooked meals, minimizing processed foods, and maintaining a food diary to increase awareness of caloric intake.
Exercise: Recommend at least 150 minutes per week of moderate aerobic activity such as brisk walking, or 75 minutes of vigorous activity like running, combined with muscle-strengthening activities on two or more days a week.
Mindfulness and Stress Management: Encourage activities like mindfulness meditation and stress-management workshops to enhance emotional and mental well-being, thereby reducing reliance on eating as a stress response.
Alcohol Reduction: Aim to cut down alcohol consumption by introducing 'dry' days and finding alternative relaxation methods.
Pharmacotherapy Management Options
For patients not achieving desired outcomes through lifestyle changes alone, pharmacotherapy offers supportive avenues. Consider these options:
Incretin Mimetics:
Tirzepatide (Zepbound): A dual GIP/GLP-1 receptor co-agonist effective in supporting weight reduction through appetite suppression and metabolic regulation.
Semaglutide (Wegovy) and Liraglutide (Saxenda): GLP-1 receptor agonists that can reduce appetite and improve glycemic control, often assisting in sustainable weight management.
Other medications:
Qsymia (Phentermine/Topiramate): Combines a sympathomimetic with an anticonvulsant to target chronic weight management, supporting reduced calorie intake and increased energy expenditure.
Contrave (Naltrexone/Bupropion): This combination of an opioid antagonist and an antidepressant can be particularly beneficial for weight management in the context of psychological factors driving eating behaviors.
Conclusion
A multidimensional intervention, beginning with structured lifestyle changes complemented by medical therapies when necessary, provides a robust framework for managing weight gain in this context. Regular follow-ups and patient education are essential in fostering long-term adherence and success.
Dr. DiPiero Video Guide to this Case Study
Resource Center
Weight Gain Resources
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