Clinical Intake — Morbid (severe) obesity due to excess calories

A 45-year-old female with a 10+ year history of severe obesity (BMI 42.3 kg/m², 262 lbs at 5'6") presents following two completed supervised dietary and behavioral weight-loss programs, each producing approximately 8 pounds of short-term loss before regain. Comorbid conditions include hypothyroidism on levothyroxine (TSH within range) and borderline glycemia on low-dose metformin; she does not carry a frank diabetes diagnosis. The referring surgeon recommends further evaluation and treatment.