Life events caused Tuan to experience constant stress, insomnia, and a tendency toward self-harm. He was diagnosed with depression and prescribed antipsychotic and sedative medications. Consequently, he developed frequent cravings and gained 50 kg in one year.

Tuan sought examination at Tam Anh General Hospital TP HCM, weighing 118 kg with a body mass index (BMI) of 37,3, indicating severe obesity. His visceral fat measured 220 cm2 (the safe threshold is 100 cm2), he had stage three fatty liver, and elevated uric acid. Laboratory results showed his triglyceride levels were high at 390 mg/dL (average is below 150 mg/dL). A specialized cardiovascular examination revealed 60% narrowing of Tuan's coronary arteries.

Master, Doctor Hoang Thi Hong Linh, from the department of endocrinology and diabetes, explained that elevated triglycerides promote atherosclerosis, myocardial infarction, and stroke. Tuan's angina attacks were a warning sign of atherosclerosis. three mental health issues related to obesity—severe depression, binge eating disorder, and night eating syndrome—were all present in Tuan.

Doctor Linh advises Tuan on weight loss treatment. *Tam Anh General Hospital*.

Doctor Linh explained that obesity and depression share a bidirectional relationship. Feelings of sadness, disinterest, anxiety, and stress increase activity in the hypothalamus-pituitary-adrenal axis, stimulating appetite and leading to overweight and obesity. Patients undergoing treatment with antidepressants or antipsychotics often experience side effects such as increased sleepiness and reluctance to exercise, making weight management difficult.

Tuan received treatment following a combined neurological therapy protocol to simultaneously lose weight and improve his psychological stability, with priorities including reducing blood fat and controlling coronary atherosclerosis.

"During the weight loss regimen, the most important aspect is to control the patient's uncontrollable cravings", doctor Linh stated, prescribing a combination of oral and injectable medications tailored to his condition to gradually reduce and eliminate appetite. After the first two weeks, Tuan's food intake decreased naturally as he felt full faster.

Tuan measures his body metrics after losing 5 kg in two weeks of treatment. *Tam Anh General Hospital*.

Tuan swam and walked, losing 5 kg in two weeks. After two months, he lost 13 kg, his angina attacks became less frequent, and his mood improved, leading the doctor to reduce his antidepressant medication. The patient aims to reduce his weight to 70 kg; otherwise, he may require coronary artery stenting to treat atherosclerosis.

Doctor Linh advised overweight and obese individuals to lose weight by combining dietary, lifestyle, and behavioral changes. She recommended using medication only as prescribed by a doctor, avoiding products of unknown origin.

Duc Hanh

*Patient's name has been changed