This week I had the pleasure of seeing a 53 year old female with a medical history significant for morbid obesity and subsequent severe hip osteoarthritis. Patient on repeat visits was counseled on weight loss and there appeared to be minimal improvement. During my evaluation I discussed many of the same topics as in the past including, PT, exercise, weight loss including surgical options. During my interview however she appeared a little withdrawn and then asked me if we have psychotherapy available. I further investigated and asked her why and she stated that she was under severe stress at home with three grown children living in her apartment, unable to help financially. She also stated that she felt like she was under significant stress and has felt sad. Her PHQ 9 was also 13. While she was not interested in medication, she was interested in psychotherapy and seemed much happier at the end of the visit. This highlights the importance of addressing underlying mood distrubances if present alsong with family support, both of which this patient had issues with.
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