He was not overweight as a teenager, but he experienced a gradual and steady weight gain to his maximum of 278 lbs. When he is careful about his eating habits, he manages to lose about 5 lbs., but this loss is quickly regained, and he has all but given up on continuing with dietary restrictions. His family history is significant for type 2 diabetes and hypertension in his father who died at age 66 of a stroke, and hypertension but no diabetes in his mother who died at age 72 of heart failure. The patient lives with his wife and two sons who are all well, and works as a gas station attendant. He does not exercise regularly.
Physical examination reveals an abdominally obese male, in no distress.
The fundi are not clearly seen. His chest is clear and the cardiovascular exam is normal to auscultation. Peripheral pulses are present but pedal pulses are weak. A faint femoral bruit is heard on the left side. Deep tendon reflexes are all intact with the exception of absent ankle reflexes.