Patient description: The patient is a 34-year-old obese woman who comes to the clinic with weight concerns. She is 165 cm tall, and her weight is 113 kg (BMI: 41.5). In the past, she unsuccessfully used antiobesity agents and appetite suppressants. She is complaining of sleep apnea, PCO and dissatisfaction with her body shape. She is a high-school teacher. She is married for 5 years. She doesn't use any contraceptive methods for the past 4 months and she had no prior pregnancies. She rarely exercises and movement seems to be hard for her. She is not able to complete the four-square step test in less than 15 seconds. She does not smoke or use any drugs. Her BP: 130/80, HR: 195/min and her BMI is: 41.54. Her lab results: FBS: 98 mg/dl TG: 150 mg/dl Cholesterol: 180 mg/dl LDL: 90 mg/dl HDL: 35 mg/dl She is considering a laparoscopic gastric bypass.

Clinical trial eligibility criteria: eligible ages (years): 18.0-65.0,  Obesity Nutritional and Metabolic Diseases Metabolic Diseases Nutrition Disorders Overweight Obese or overweight at screening defined as: BMI greater than or equal to 30 kg/m2 and <50 kg/m2 or BMI greater than or equal to 27 kg/m2 and <50 kg/m2 in the presence of controlled hypertension and/or treated or untreated dyslipidemia. For patients receiving antihypertensive and/or hypolipidemic medications, these should have been at a stable dosage for at least 2 months before the start of the run-in period. Controlled hypertension is defined as a diastolic blood pressure <100 mmHg and a systolic blood pressure <160 mmHg, in the presence of antihypertensive drug treatment. For patients who are not on lipid-lowering drugs, dyslipidemia is defined as LDL-C greater than or equal to 3.4 mmol/L (130 mg/dL), HDL C <1 mmol/L (40 mg/dL) for men or <1.3 mmol/L (50 mg/dL) for women, or triglycerides greater than or equal to 1.7 mmol/L (150 mg/dL) A stable weight, i.e., increasing or decreasing not more than 5 kg in the 3 months before the start of the run-in period Consumption of breakfast and dinner on a daily basis Ability to swallow the intact capsule (17.5 mm in length and 9.1 mm in diameter) with water, as judged by e.g., the patients's history of having no difficulty with swallowing e.g., capsules or intact tablets Fasting plasma glucose <7.0 mmol/L (126 mg/dL) at screening Women must be postmenopausal or surgically incapable of childbearing or if sexually active, be practicing an effective method of birth control  History of obesity with a known cause (e.g., Cushing's disease) History of anorexia nervosa, bulimia, or binge-eating disorder An established diagnosis of diabetes mellitus or treatment with glucose lowering prescription drugs at screening Prior exposure or known contraindication or hypersensitivity to R256918 History of weight-reducing diet or receiving any drugs to treat obesity within the 3 months prior to screening Treatment with any investigational drug or device within 1 month before the start of the run-in period History or evidence of liver or renal impairment History of HIV or presence of hepatitis C antibodies or positive hepatitis B serology History of clinically significant gastro-intestinal disease History of major gastro-intestinal surgery other than appendectomy or uncomplicated cholecystectomy