Patient presents today for evaluation and management of obesity.  The patient reports concerns regarding weight gain, difficulty with mobility, and decreased energy levels.  Review of systems reveals positive findings for shortness of breath with exertion, daytime fatigue, and difficulty sleeping.  Past medical history is significant for hypertension and hyperlipidemia.  Family history is positive for type 2 diabetes and cardiovascular disease.  Physical examination reveals an elevated BMI of 35.2 kgm2, classifying the patient as obese Class II.  Waist circumference is measured at 45 inches, indicating abdominal obesity and increased risk for metabolic syndrome.  Blood pressure is elevated at 14090 mmHg.  Diagnostic workup may include fasting blood glucose, lipid panel, and liver function tests to assess for obesity-related comorbidities.  The patient's obesity diagnosis is determined based on BMI and clinical presentation.  Differential diagnoses considered include hypothyroidism and Cushing's syndrome.  The patient was counseled on lifestyle modifications, including dietary changes focusing on calorie reduction and increased consumption of fruits and vegetables, and increased physical activity with a goal of at least 150 minutes of moderate-intensity exercise per week.  Referral to a registered dietitian and a certified fitness trainer was recommended.  Pharmacotherapy options for weight management were discussed, and the risks and benefits were explained.  The patient will follow up in one month to assess progress and adjust the treatment plan as needed.  ICD-10 code E66.9 Obesity, unspecified is assigned.  Medical billing codes for this encounter may include 99214 for an established patient office visit with moderate complexity.  Emphasis was placed on patient education regarding the importance of weight loss for improving overall health and reducing the risk of long-term complications associated with obesity.