Patient presents with severe obesity, clinically diagnosed as a body mass index (BMI) of 40.5 kg/m2, exceeding the threshold for class III obesity.  The patient reports significant weight gain over the past five years, attributed to a combination of poor dietary habits, including high caloric intake and consumption of sugary drinks, and a sedentary lifestyle with limited physical activity.  Associated health risks related to severe obesity were discussed, including increased risk of type 2 diabetes, hypertension, cardiovascular disease, obstructive sleep apnea, osteoarthritis, and certain types of cancer.  The patient acknowledges the health implications and expresses motivation for weight loss.  Current medications include over-the-counter ibuprofen for occasional knee pain.  Physical examination reveals elevated blood pressure (140/90 mmHg) and abdominal adiposity.  Laboratory tests were ordered to assess for comorbidities, including fasting blood glucose, lipid panel, and liver function tests.  Initial treatment plan includes lifestyle modifications, focusing on dietary changes with a calorie-controlled diet rich in fruits, vegetables, and lean protein, and increased physical activity with a goal of at least 150 minutes of moderate-intensity exercise per week.  Referral to a registered dietitian for nutritional counseling and a certified fitness trainer for exercise guidance is recommended.  Consideration for bariatric surgery will be discussed pending laboratory results and response to initial lifestyle interventions.  Patient education provided on the health risks of severe obesity, benefits of weight loss, and strategies for long-term weight management. Follow-up appointment scheduled in four weeks to monitor progress and adjust the treatment plan as needed.