A 32-Year-Old Man With a BMI of 32.5 and BP of 138/92

Editor's Note: Based on the 2013 Blood Cholesterol, Lifestyle Management, Obesity, and Risk Assessment Guidelines.

A 32-year-old man has gained 35 pounds since he graduated from college and started working as computer programmer. He has never smoked. He has treated hypertension. He has tried several popular diets to lose weight and lost about 20 pounds each time, but he always regains the weight lost within one year. He bowls once a week. He weighs 220 lbs and his BMI is 32.5, and the highest it has ever been. His BP is 138/92. His labs show total cholesterol 218 mg/dL, triglycerides 188 mg/dL, HDL–C 40 mg/dL, LDL–C 138 mg/dL, and non HDL–C 178 mg/dL. His fasting glucose is 101 mg/dL. His father died of an MI at age 73.

Which of the following should be incorporated into your advice for ASCVD risk reduction for him?

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