A 45-year-old man presents to his physician. He has not been in for an annual exam in 5 years, at which time, he was diagnosed with prediabetes (fasting plasma glucose [FPG], 115 mg/dL; A1c, 6.0%) and was overweight, with a body mass index (BMI) of 27.1. His height is 6 ft, and he has a body weight of 200 lb.

The patient reports working long hours at a stressful job in finance. He does not have regular mealtimes and often relies on catering that is brought to the office or convenience/fast food meals. He consumes multiple cups of coffee and at least one 20-oz bottle of caffeinated soda per day to maintain his energy. He is sedentary. On weekends, he mostly sleeps, relaxes at home watching television, or goes out with friends to sports bars to watch games, where he consumes multiple beers and a variety of bar food. He reports being woken up by his own snoring regularly.

Physical exam reveals central adiposity and a visually increased neck circumference. He has gained 40 lb since his last visit and is now 240 lb (BMI, 32.5). His breathing is labored and there is slight wheezing on auscultation. Tender, slight hepatomegaly is detected on palpation. There are several skin tags around his neck. Blood pressure is 135/85 mm Hg.