Patient profile: Female, 39 years old, BMI 36 kg/m2.

Presentation: The patient had obesity, irregular periods, difficulty losing weight despite many previous diets, daytime tiredness, PCOS and likely obstructive sleep apnoea.

Assessment: Assessment included metabolic blood tests, HbA1c, fasting insulin, androgen profile, thyroid function, sleep study referral, eating pattern review, binge eating screening and body composition analysis.

Clinical picture: This was obesity complicated by probable PCOS, insulin resistance and sleep apnoea, all contributing to poor weight regulation and metabolic disruption.

Support plan: The plan was multidisciplinary and involved endocrinology, gynaecology, sleep medicine and dietetics where appropriate. Nutrition focused on a lower-carbohydrate Mediterranean pattern with a 10 to 12 hour eating window, high-quality protein, fibre and healthy fats. Sleep apnoea support included positive airway pressure where indicated. Pharmacological support included consideration of a GLP-1 receptor agonist. Nutraceuticals included inositol at 2 to 4 g daily, berberine where suitable, and vitamin D replacement if low. Behavioural support included CBT, habit coaching and regular accountability. Exercise focused on resistance training to preserve lean mass and increase metabolic rate.

Outcome at 9 months: The patient achieved 12% weight loss. Menstrual cycles became regular again. Fasting insulin and HOMA-IR improved. Daytime tiredness improved after CPAP support started. Mood and body image also improved.

Key point: Weight management becomes more effective when sleep, hormones, eating patterns and behaviour are addressed together.