Thanh, standing 1.65 m tall with a 105 cm waist, sought treatment for obesity at Tam Anh General Hospital in Hanoi. Doctor Le Ba Ngoc, Deputy Director of the Weight Control and Obesity Treatment Center and Head of the General Internal Medicine Department, noted that the patient had class two obesity (BMI 30), visceral fat of 147 cm2 (normal is below 100 cm2), high blood pressure, type 2 diabetes, blood lipid disorders, and had suffered a stroke two years prior.

A CT scan revealed miniature atherosclerotic plaques causing narrowing of the V4 segment of the patient's right vertebral artery. This is a crucial artery supplying blood to the brain, and narrowing increases the risk of stroke.

In the patient's head and neck area, doctors discovered fluid accumulation in the left maxillary sinus, possibly related to sinusitis. His chest showed mucus accumulation in the lower lobe bronchi of the right lung, a sign of lower respiratory tract inflammation. Thanh's coronary arteries displayed plaques causing mild to moderate narrowing (10-50%) in several locations, signaling a risk of coronary artery disease. His right kidney had multiple fat nodules at the upper pole, and his abdominal aorta was about 30% narrowed.

Medical staff prepare Thanh for a full-body CT scan. Photo: *Tam Anh General Hospital*

According to Doctor Ngoc, the patient's class two obesity and systemic vascular damage reduced blood supply to the brain and heart, increasing the risk of blood clots causing a heart attack or stroke. Without weight loss, obesity and excess visceral fat would exacerbate chronic inflammation and atherosclerosis, leading to more severe and difficult-to-manage cardiovascular complications.

The patient, a daily smoker, was advised to quit smoking and undergo medical treatment with a multi-target drug regimen, including antiplatelet medication to prevent blood clot formation and medication to lower blood lipids. Concurrently, he received treatment for obesity with weight-loss medication and medication for diabetes and hypertension to avoid metabolic effects.

Thanh's CT scan shows atherosclerosis of the right coronary artery and narrowing of the V4 segment of the right vertebral artery. Photo: *Tam Anh General Hospital*

A nutritionist developed a personalized diet plan for him, reducing excess calories while ensuring adequate nutrients. He began a moderate exercise program, gradually increasing the duration based on his body's adaptation.

After a month of following the treatment plan, Thanh lost 4 kg and reduced his visceral fat area by 20 cm2. He continues to maintain the weight-loss plan and attends regular follow-up appointments to monitor the condition of his coronary and vertebral arteries, allowing for timely medication adjustments.

Minh Anh

*The patient's name has been changed.