Introduction
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Margaret, an obese, well-dressed 45 year old woman whom you have been treating for recurrent thrush presents as you requested, one week after her initial visit. She dislikes exercise and has not started swimming, which you recommended last visit as she is embarrassed by her body size and confides she cannot find any bathers to fit her.

Her pathology results from the previous visit are:

Fasting blood glucose = 8.8 mmol/l
Total cholesterol = 6.2 mmol/l
HDL cholesterol = 0.8 mmol/l
Triglycerides = 4.6 mmol/l
LDL cholesterol cannot be calculated due to interference from the elevated triglycerides

Medical history: long-standing hypertension well controlled on Natrilix (indapamide).
Except for the thrush, she denies symptoms of hyperglycaemia
Height: 168 cm, body weight 90.3 kg, waist circumference 97 cm, BMI 32.0 kg/m2, central adiposity. All else normal, including no other features of Cushing's syndrome and no evidence of peripheral neuropathy with intact ankle jerks and ability to feel the 10 g monofilament in both feet.