A 45-year-old man comes to your office for a follow-up discussion about his recent physical examination and laboratory work. The examination was his first visit for medical care since age 20, when he needed a physical for employment.

The following findings were pertinent:

• no known past medical history
• sedentary lifestyle
• no medical complaints
• normal exam, except for a body mass index (BMI) of 33 with a weight gain of 30 lb over the previous 10 years
• unremarkable laboratory test results, except for a fasting blood sugar of 115 mg/dL and an A1c of 7.5%.

He is reluctant to take medications.